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OFFICERS  OF  CITIZENS  MEDICAL 
REFERENCE  BUREAU 

Secretary-Treasurer — H.  B.  Anderson,  New  York  Qty. 

Board  of  Directors 
Charles  T.  Root,  New  York  City. 
Ckarles  H,  Ingersoll,  New  York  City. 
Herbert  Everett,  Grantwood,  New  Jersey. 


STATE  MEDICINE  A  MENACE 
TO  DEMOCRACY 


By  H.  B.  ANDERSON 

Secretary-  Treasurer 
Citizens  Medical  Reference  Bureau 


Published  by 

CITIZENS  MEDICAL  REFERENCE  BUREAU 

145  W.  45th  Street,  New  York,  N.  Y. 

1920 


mmm^irtmmim'm^'mim^mif^irm^ .  n  11  U  '  U  I  I.  I  I        i    1    I   i| 


FOREWORD 

This  book  presents  a  disinterested  analysis  of  erroneous 
principles  of  public  health  policy.  It  points  out  the  serious 
consequences  of  allowing  these  erroneous  principles  to  play 
such  a  prominent  part  in  the  shaping  of  our  public  health 
activities.  It  calls  attention  to  the  enormous  appropriations 
now  being  made  for  alleged  public  health  activities  and  their 
tendency  to  increase  in  size.  It  explains  the  seeming  paradox 
that  the  larger  these  appropriations  become  the  greater  the 
failure  to  conserve  public  health  and  the  more  the  enjoyment 
of  "life,  liberty  and  the  pursuit  of  happiness"  is  being  taken 
away  from  the  American  people. 

The  purpose  of  this  book  is  to  meet  the  needs  of  legisla- 
tors, social  workers,  health  officers,  teachers,  college  and  uni- 
versity students,  lawyers,  clergymen,  authors,  editors  and 
others  interested  in  the  promotion  of  public  health.  It  is 
written  in  a  simple,  untechnical  language  and  is  arranged  and 
classified  in  such  a  manner  that  the  average  citizen  may  un- 
derstand it  and  find  what  he  is  most  interested  in  as  quickly 
as  possible.  It  discusses  the  evils  of  state  medicine  in  a  gen- 
eral way  and  also  under  special  subjects  including  the  fol- 
lowing, "Fallacy  of  Plea  for  Medical  Control  Through  Aledical 
Practice  Acts",  "Medical  Examination  of  School  Children 
Ineffective  and  in  Many  Cases  Actually  Harmful"  and  "Com- 
pulsory Vaccination  Is  Based  Upon  Superstition,  Commer- 
cialism and  Paternalism". 

The  book  is  based  on  a  painstaking  study  of  the  most  im- 
portant official  documents  and  periodicals  issued  by  healtli 
departments,  leading  medical  and  sociological  organizations 
and  other  publications  bearing  on  the  subject  of  public  health. 


ENLIGHTENING  QUOTATIONS 

"With  entire  consistency,  health  wardenship  of  cities  has 
been  committed  solely  to  physicians,  those  who  by  training 
have  been  taught  to  consider  the  pathological  in  human  life, 
the  symptomatology  and  evidences  of  disease  rather  than 
the  great,  basic,  underlying  essential  factors  which  enter 
into  and  are  the  vital  part  in  the  creation,  spread  and  per- 
petuation of  sickness." — W.  C.  Rucker,  Assistant  Surgeon- 
General,  U.  S.  Public  Health  Service. 

"The  responsibility  of  protecting  the  public  from  disease 
and  of  securing  better  health  conditions  belongs  to  the  peo- 
ple. It  is  not  the  function  of  the  medical  profession  to 
maintain  lobbies  or  to  endeavor  to  secure  public  health 
measures  by  political  methods.  .  .  .  The  responsibility 
for  public  health  conditions  must  rest  with  the  people  and 
not  with  any  special  class  or  profession.  The  sooner  these 
general  principles  are  recognized,  the  better  it  will  be  for 
the  medical  profession  and  for  public  health  advancement." 
— Journal  of  the  American  Medical  Association. 

"Sanitary  science  and  preventive  medicine  are  funda- 
mentally separate  and  distinct  from  the  practice  of  medi- 
cine as  a  healing  art.  It  would  be  a  lamentable  confusion 
of  functions  and  duties  if  the  view  were  to  gain  general 
acceptance  that  the  medical  profession,  as  represented  by 
practicing  physicians  and  surgeons,  is  to  be  considered 
'the  guardian  of  the  public  health.'  " — Frederick  L,  Hoff- 
man, LL.  D.,  Statistician  and  Third  Vice-President  of  the 
Prudential  Insurance  Company  of  America. 

"Another  error  into  which  we  have  fallen  as  a  profession 
is  the  tendency  to  regard  the  medical  profession  as  a  di- 
vinely authorized  class,  whose  sacred  and  distinctive  func- 
tion is  the  protection  of  the  people  either  with  or  without 
their  consent.  .  .  .  too  often  medical  organizations,  as 
well  as  individual  physicians,  have  taken  the  position  that 
they  were  the  courts  of  last  resort;  that  it  was  their  special 
function  to  dictate  the  terms  of  public  health  legislation, 
and  that  it  was  the  duty  of  the  public  to  accept  their  de- 
cisions and  acquiesce  in  their  judgment." — Dr.  Frederick  R. 
Green,  Secretary,  Council  on  Health  and  Public  Instruc- 
tion, American  Medical  Association. 

"Disease  is  an  ally  of  ignorance,  dirt  and  disorder,  and  it 
everywhere  tends  to  disappear  on  the  improvement  of 
knowledge  and  of  social  conditions.  Standards  of  per- 
sonal, domestic  and  municipal  living  are  ever  advancing 
and  sweeping  away  the  opportunities  that  formerly  existed 
for  the  spread  of  infection." — George  A.  Soper,  Ph.  D. 
Major,  Sanitary  Corps,  U.  S.  Army. 


"Every  encroachment,  great  or  small,  is  important 
enough  to  awaken  the  attention  of  those  who  are  entrusted 
with  the  preservation  of  a  constitutional  government.  We 
are  not  to  wait  till  great  public  mischiefs  come,  till  the 
government  is  overthrown,  or  liberty  itself  put  into  extreme 
jeopardy.  We  should  not  be  worthy  sons  of  our  fathers 
were  we  so  to  regard  great  questions  affecting  the  general 
freedom." — Daniel  Webster. 

"The  exercise  of  medical  functions,  whether  the  regula- 
tion of  medical  practice  or  preventive  medicine,  is  under 
state  control,  and  I  think  it  is  rather  fortunate  that  this  is 
the  case,  because,  divided  as  we  are  into  forty-eight  politi- 
cal groups,  we  do  not  have  to  make  the  same  experiments 
at  the  same  time." — Dr.  Victor  C.  Vaughan. 

"The  American  Medical  Association  is  perhaps  the  best 
illustration  of  the  effect  of  the  organization  furore.  It  has 
become  to  all  intents  and  purposes  a  huge  oligarchy.  Its 
policies  are  directed  by  a  few  who,  ostensibly  acting  as  the 
agents  of  the  members,  in  reality  take  the  initiative  in  every 
movement,  assisted  thereto  by  the  constitution  of  the  so- 
ciety itself.  The  spirit  of  democracy  is  as  foreign  to  it  as 
it  is  in  the  realm  of  the  Czar  of  all  the  Russias.  It  is  the 
natural  result  of  the  modern  trend  of  concentration,  subor- 
dinating private  judgment  to  the  leaders'  dictum." — Lancet- 
Clinic,  Cincinnati,  Ohio. 

"Unless  the  drift  toward  Bureaucratic  Government  is 
stopped,  Americans  will  be  the  most  ruled  and  standard- 
ized people  in  the  world,  and  we  will  need  armies  of  citi- 
zens to  enforce  all  the  laws;  by  and  by  we  shall  all  be 
government  employes,  earning  our  pay  by  watching  one 
another.  Then,  surely,  the  millennium  will  have  been 
reached." — Illinois  Medical  Journal. 

"The  trend  and  spirit  of  medical  schools  is  toward  cura- 
tive medicine.  The  graduates  of  our  best  medical  schools 
today  are  not  fitted  to  do  public  health  work.  ...  It  is 
a  matter  for  consideration  whether  the  medical  profession 
should  fit  men  for  preventive  medicine  or  turn  the  job  over 
to  somebody  else.  The  sanitary  engineer  as  an  all  around 
man  is  better  fitted  as  an  epidemiologist  than  the  average 
physician." — Dr.  Victor  C.  Vaughan. 

"The  relation  of  the  Church,  or  of  all  the  Churches,  to 
the  State  is  one  of  the  problems  Tvhich  the  Republic  may  be 
said  to  have  solved.  It  is  decided  that  it  has  no  relation 
whatever.  The  State  has  as  much  relation  to  religion  as 
to  medicine,  and  no  more;  and  it  might  as  well  establish 
Homeopathy  as  its  medical  system,  as  Episcopacy  as  its 
religion." — The  late  Andrew  Carnegie. 

"With  all  the  wonderful  strides  of  our  science  in  one 
hundred  years,  we  still  have  the  public  as  abjectly  cowed 
today,  before  the  omnipotent  hosts  of  bacteria,  as  it  was  by 
the  evil  spirits  and  ghosts  and  witches  of  a  past  century."-— 
Dr.  Park  L.  Myers,  Toledo,  Ohio. 


"When  a  doctor  notes  what  he  considers  good  effects 
from  his  own  practice,  it  is  natural  for  him  to  let  well 
enough  alone,  and  refrain  from  exploring  unknown  lines. 
.  .  .  But  when  ignorance  and  narrowness,  instead  of 
being  humble,  grow  insolent  and  authoritative,  and  ask 
for  laws  whose  only  immediate  result  can  be  to  conse- 
crate and  perpetuate  them,  then  I  think  that  every  citizen 
interested  in  the  growth  of  a  genuinely  complete  medical 
science  should  rise  up  and  protest." — The  Late  Professor 
William  James. 

"Not  only  in  regard  to  therapeutics  do  we  find  a  tend- 
ency to  fads.  We  can  observe  a  similar  tendency  in  regard 
to  broad  pathologic  and  diagnostic  questions." — Dr.  Joseph 
Zeisler. 

"It  is  the  plain  duty  of  the  school  authorities  to  see  to  it 
that  the  school  buildings  and  all  places  where  the  students 
assemble  for  study  are  safe,  sanitary,  cornfortable,  well 
lighted  and  ventilated,  and  in  every  way  suitable  and  cal- 
culated to  facilitate  and  promote  the  work  to  be  there  per- 
formed. When  they  assume  to  go  beyond  this,  and  to  take 
charge  of  the  physical  condition  and  health  of  the  pupil 
we  believe  they  have  transcended  their  functions.  This 
duty  should  be  left  to  the  parent  or  legal  guardian,  where 
it  properly  belongs." — William  Nottingham,  M.  A.,  Ph.  D., 
LL.  D.,  a  Regent  of  the  University  of  the  State  of  New 
York. 

"A  healthy  mental  attitude  is  the  greatest  of  all  helps 
in  preserving  physical  sanity;  break  down  a  healthy  men- 
tal attitude,  and  the  baleful  germs  that  are  in  all  of  us 
will  riot  uncontrolled.  If  all  the  employees  of  a  bank  are, 
according  to  the  medical  examiner,  pathological  cases, 
what  number  of  the  employes  of  a  factory  or  a  depart- 
ment store  would  be  pronounced  entirely  sound?  Virtually 
all  of  us  go  through  life  with  engines  that  are  more  or  1^ 
imperfect,  but  that  do  their  work  satisfactorily  enough  Ts 
long  as  we  do  not  watch  them,  tinker  over  them  and  fuss 
with  them.  A  compulsory,  universal  medical  examination 
would  probably  result  in  widespread  depression  and 
despair." — The   Youth's   Companion. 

"  'Those  to  whom  the  care  of  delicate  mechanical  ap- 
paratus is  entrusted,'  says  Dr.  Goldwater,  'do  not  wait 
until  a  breakdown  occurs,  but  inspect  and  examine  the 
apparatus  minutely,  at  regular  intervals,  and  thus  detect 
the  first  signs  of  damage.'  This  is  the  favorite  simile  of 
the  health-enthusiasts.  But  in  it  are  imbedded  two  fatal 
fallacies.  In  the  first  place,  the  working  of  a  machine 
is  not  affected  by  our  concern  over  it,  while  our  body  may 
be.  And  secondly,  the  only  interest  we  have  in  the  ma- 
chine is  that  it  shall  function  well  as  a  mechanism;  while 
in  the  case  of  our  bodies  we  may  deliberately  choose  to 
sacrifice  perfection  of  the  mechanism  to  other  objects 
which  we  prize  more  highly — indeed,  we  must  do  so,  at 
some  point  or  other,  if  we  wish  to  keep  out  of  Bedlam." — 
New  York  Evening  Post. 


"There  are  many  indications  that  we  are  drifting  toward 
the  pernicious  notion  that  the  citizen  is  the  ward  of  the 
state.  This  conception  is  not  only  unworthy  of  us  and 
our  times,  but  it  is  unjust  to  him  and  tends  to  lessen  his 
self-dependence,  impair  his  self-respect,  and  hamper  his 
efforts  to  reach  his  highest  destiny.  We  would  much 
better  take  the  loftier  and  more  healthful  view,  that  the 
average  American,  by  birth,  amid  our  institutions,  is  nat- 
urally endowed  with  a  keen  sense  of  his  personal  rights 
and  privileges,  with  an  abounding  ambition  to  do  things 
and  a  large  capability  of  looking  out  for  himself.  We  are 
ages  in  advance  of  the  Spartan  regime  under  which  the 
child  at  birth  was  examined  by  the  ruling  elders  to  de- 
termine whether  or  not  he  was  fit  to  be  reared,  and  at  the 
age  of  seven  was  taken  over  by  the  state." — William  Not- 
tingham, M.  A.,  Ph.  D.,  LL.  D. 

"In  many  cases  physicians  become  interested  in  the  strict 
enforcement  of  the  law  because  of  the  fees  resulting  there- 
from. ...  In  the  more  populous  districts  the  medical 
fees  resulting  from  vaccination  are  an  important  item. 
.  .  .  It  is  not  claimed  that  physicians  as  a  rule  are  gov- 
erned in  this  matter  by  a  mercenary  motive.  .  .  .  How- 
ever, this  mercenary  motive  has  been  the  controlling  factor 
in  a  sufficient  number  of  cases  which  have  come  to  the  at- 
tention of  this  Department  to  justify  the  above  assertion." 
— From  Fifth  Annual  Report  by  Andrew  S.  Draper,  Com- 
missioner of  Education,  New  York  State,  January  25,  1909. 

"The  conclusion  is  in  every  case  the  same;  that  vaccina- 
tion is  a  gigantic  delusion;  that  it  has  never  saved  a  single 
life;  but  that  it  has  been  the  cause  of  so  much  disease, 
so  many  deaths,  such  a  vast  amount  of  utterly  peedless 
and  altogether  undeserved  suffering,  that  it  will  be  classed 
by  the  coming  generation  among  the  greatest  errors  of  an 
ignorant  and  prejudiced  age,  and  its  penal  enforcement 
the  foulest  blot  on  the  generally  beneficent  course  of  leg"- 
islation  during  our  century." — Professor  Alfred  Russel 
Wallace. 

"Coincident  with  the  descending  curve  in  tuberculosis 
mortality  people  were  living  cleaner,  better  and  more 
wholesome  lives  and  interest  in  general  health  was  stead- 
ily increasing.  While  we  were  passing  through  our  early 
hysterical  fear  of  infection,  in  our  frenzied  battle  with  the 
tubercle  bacillus,  and  were  awakening  from  our  over-col- 
ored dreams  of  short  cuts  to  cure,  scores  of  medical  and 
social  agencies  were  coming  into  life  trying  to  solve  the 
problems  of  better  living  and  of  better  health.  What  part 
these  agencies  have  had,  since  1882,  in  shaping  the  down- 
ward cure  of  tuberculosis  mortality,  is  beyond  accurate  de- 
termination. Our  thoughtful  conjecture  is  that  it  has  been 
large,  and  so  believing",  we  must  consider  to  what  greater 
extent  these  forces  and  agencies  may  be  employed  in  con- 
tinuing that  curve  which  is  still  too  far  from  the  bottom 
of  the  scale." — George  Thomas  Palmer, 


CONTENTS 

Chapter  Page 

FOREWORD 

I.       FALLACY  OF  CONTENTION  THAT  PUBLIC 
HEALTH  WORK  IS  CHIEFLY  A  MEDICAL 

PROBLEM     1 

Medical  Authorities  Call  Attention  To  Mistake  of 
Regarding  Medical  Profession  As  Guardians  of 

Public  Health  2 

Medical  Teachings  of  Health  Boards  Create  Fear..     4 

Relation  of  Sanitation   to   Public  Health (i 

Relation  of  Higher  Living  Conditions  to   Public 

Health 8 

Relation  of  Family  Income  to  Public  Health 9 

Analysis    of    Appropriations    for    Alleged    Public 
Health   Purposes  11 

XL     DEVELOPMENT  OF  AND  PLAN  FOR  STATE 

MEDICINE 14 

Compulsion  the  Key-Note 14 

The  Term  "State  Medicine"  Defined 15 

Domination  of  Public  Health  Activities  by  Phy- 
sicians    15 

Laws  and  Regulations  Now  in  Force 17 

Styles  in  Medical  Legislation 17 

Efforts  to  Secure  National  Department  of  Health.  18 

Compulsory  Health  Insurance  Proposed 22 

Seek  Medical  Control  of  Children 22 

Bill  for  Card-Indexing  Everybody 23 

Sponsors  of  Legislation  for  State  Medicine 24 

Efforts  to  Secure  Assistance  of  Philanthropic  Or- 
ganizations      26 

Should  the  Motive  Be  Questioned? 27 

Opposition  Within  Allopathic  Medical  Profession  27 


Chapter  Page 

III.  PREVENTIVE  MEDICINE  PROGRAM  NOT 

CONDUCIVE  TO   PUBLIC   HEALTH 23 

Public  being  Taught  to  Think  of  Disease  Instead 

of   Health 29 

An  Age  of  Vaccines  and  Serums  31 

The  "Carrier"  Theory  32 

Says  Program  Increases  Physicians'  Practice 36 

Tendency  Is  to  Belittle  Value  of  Real  Sanitation....  37 

IV.  PRACTICE  OF  HEALING  ART  A  PRIVATE 
FUNCTION  40 

Practice  of  Medicine  in  Washington's  Time 41 

Tendency  to  Fads 42 

Says  Not  Always  Able  to  Get  Bearings 43 

Failure  to  Distinguish  Between  Therapeutics  and 

Sound  Public  Health  Measures 46 

Five   Deaths   Caused  By  Toxin- Antitoxin 47 

V.  GERM   THEORY   THE    BASIS   FOR   MUCH 

UNJUST   LEGISLATION 49 

Bacteriophobia  and  Health  Board  Folly 49 

Medical  Profession  Not  Unanimous  in  Acceptance 

of  the  Germ  Theory  50 

Official  Medical  Journal  Warns  Against  the  Dread 

of  Microbes  52 

Says  People  Have  Been  Frightened  Into  Panicky 

Laws  53 

VI.  FALLACY  OF  PLEA  FOR  MEDICAL  CON- 

TROL THROUGH  MEDICAL  PRACTICE 

ACTS 56 

Practice  of  "  Regular"  Physicians  Is  Exclusive 57 

Training  in  Medical  Diagnosis  No   Criterion  for 

Practice   of  Healing  Art 60 

Scholarship  Not  the  Final  Criterion „ 63 


Chapter  Page 

VII.  MEDICAL     EXAMINATION     OF     SCHOOL 

CHILDREN  INEFFECTIVE  AND  IN  MANY 

CASES  ACTUALLY  HARMFUL 65 

Mistakes  in  Diagnosis  Not  Uncommon „...  65 

Says    Diagnosis   May   Depend   on   "Psychological 

Influence"    68 

Majority  of  Medical  Examinations  "Farcical" 69 

Medical  Examinations  Tend  to  Fasten  Disease  on 

Children   „ 70 

Children's  Bureau  Campaign  a  Failure 72 

Rural  Districts,  Without  Medical  Inspection,  etc., 

Healthier  Than  Cities 73 

Medical  Examinations  of  Children  a  Step  Toward 

Compulsory    Medical    Treatment 75 

Metropolitan  Daily  Doubts  If  Universal  Medical 

Examinations  Are  Worth  the  Price 77 

University  Regent  Attacks  Medical  Examinations 

as  Paternalistic  and  Unwarranted 79 

Viin.  COMPULSORY   VACCINATION   IS  BASED 
UPON  SUPERSTITION,  COMMERCIALISM 

AND  PATERNALISM   82 

Smallpox  Reduction  Due  to  Sanitation 84 

Vaccination  a  Surgical  Procedure,  Sometimes  Fol- 
lowed by  Severe  and  Even  Fatal  Results 87 

Compulsory  Vaccination  Fostered  by  Commercial- 
ism   88 

Existing  Laws  and  Regulations..™ 91 

Compulsory  Vaccination  Forbidden 92 

Why  North  Dakota  Abolished  Compulsory  Vac- 
cination    92 

IX.     FAILURE  OF  MEDICAL  CONTROL  WHERE 
MOST  COMPLETE  AN  INDICTMENT  OF 

STATE  MEDICINE  96 

Experience  in  the  Army 96 


Chapter  Page 

Experience  in  the  Navy 101 

Tuberculosis  Campaign  a  Failure 102 

Campaign  Founded  on  Fear 102 

Value    of   Sanatoriums    Over-estimated 103 

Statistics    Fail   to    Show   Any   Favorable   Results 

from  Antituberculosis  Campaign 104 

Failure  of  Medical  Control  in  Influenza  Epidemic..l06 

X.      THE     CONSTITUTION     A     PROTECTION 

AGAINST  STATE  MEDICINE 109 

Liberty  Highly  Prized  by  Our  Forefathers 110 

Liberty  in  Jeopardy Ill 

The  Citizen's  Duty 112 

INDEX    ...„ 113 


CHAPTER  I. 

FALLACY    OF    CONTENTION    THAT    PUBLIC 

HEALTH  WORK  IS  CHIEFLY  A  MEDICAL 

PROBLEM. 

"Unfortunately,  health  has  been  considered  in  the  past  only  as  a 
medical  problem,  and  the  pendulum  has  been  enthusiastically  swung 
so  far  that  health  is  almost  regarded  as  an  artificial  state  to  be 
achieved  and  maintained  solely  through  the  interposition  of  medical 
safeguards. 

"With  entire  consistency,  health  wardenship  of  cities  has  been 
committed  solely  to  physicians,  those  who  by  training  have  been 
taught  to  consider  the  pathological  in  human  life,  the  symptoma- 
tology and  evidences  of  disease  rather  than  the  great,  basic,  under- 
lying essential  factors  which  enter  into  and  are  the  vital  part  in  the 
creation,  spread  and  perpetuation  of  sickness." — Assistant  Surgeon- 
General  W.  C.  Rucker,  U.  S.  Public  Health  Service.* 

THE  plea  for  state  medicine,  including  compulsory  med- 
ical examination  and  treatment  of  everybody,  is  based 
upon  the  contention  that  public  health  work  is  chiefly 
a  medical  problem.  It  is  obvious  that  the  more  the  people 
can  be  persuaded  to  turn  local,  state  and  national  public  health 
activities  over  to  physicians  of  one  school  of  healing  the  more 
opportunities  that  particular  school  of  healing  will  have  to 
promote  the  interests  of  its  members  at  the  expense  of  other 
systems  of  healing  and  the  public  generally.  It  is  only  natu- 
ral, therefore,  that  every  effort  should  be  made  by  the  domi- 
nant school  of  medicine  to  have  the  public  believe  that  public 
health  work  is  chiefly  a  medical  interest.  A  number  of  promi- 
nent physicians  and  medical  journals,  however,  have  recently 
called  attention  to  the  fallacy  of  regarding  public  health  work 
as  chiefly  a  medical  problem.  Reference  is  here  made  to  a 
few  such  admissions. 


^"A  Program  of  Public  Health  for  Cities,"  by  Dr.  Rucker  before  the  Cincinnati 

Convention  of  the   American    Public   Health  Association,    October  24,    1916,   and 

?uoted  from   in  an  article  in   the   American  Journal  of    Public   Health,  January, 
920.  p.  9. 


Medical  Authorities  Call  Attention  to  Mistake  of  Regard- 
ing Medical  Profession  as  Guardians  of  the  Public  Health. 

— The  Journal  of  the  American  Medical  Association,  the  offi- 
cial organ  of  the  American  Medical  Association,  the  leading 
organization  of  allopathic  or  so-called  "regular"  physicians  in 
the  United  States,  recently  voiced  what  is  probably  the  senti- 
ment of  a  large  per  cent  of  the  members  of  that  association 
although  directly  contrary  to  the  policy  of  that  association  for 
the  past  quarter  of  a  century.  Referring  to  a  bill  introduced 
in  the  Ohio  Legislature  the  Journal  said^: 

"The  medical  profession  has  performed  its  full  duty  in 
pointing  out  the  danger  to  public  health  which  would  be  in- 
volved in  its  passage.  Whatever  action  is  taken  by  the  Legis- 
lature will  be  with  full  knowledge  of  the  consequences.  This 
is  the  ideal  attitude  for  physicians  to  take,  as  should  have  been 
recognized  long  ago.  The  responsibility  of  protecting  the 
public  from  disease  and  of  securing  better  health  conditions 
belongs  to  the  people.  It  is  not  the  function  of  the  medical 
profession  to  maintain  lobbies  or  to  endeavor  to  secure  public 
health  measures  by  political  methods.  The  true  function  of 
the  medical  profession  is  to  advise  the  people,  to  show  them 
how  to  protect  themselves.  The  doctor's  mission  is  to  be  a 
teacher  and  not  a  political  manipulator.  The  responsibility 
for  public  health  conditions  must  rest  with  the  people  and  not 
with  any  special  class  or  profession.  The  sooner  these  gen- 
era! principles  are  recognized,  the  better  it  will  be  for  the 
medical  profession  and  for  public  health  advancement." 

In  a  publication  entitled  "Facts  and  Fallacies  of  Compul- 
sory Health  Insurance,"  Frederick  L.  Hoffman,  LL.  D.,  Sta- 
tistician and  Third  Vice-President  of  the  Prudential  Insur- 
ance Company  of  America,  says: 

"According  to  Dr.  I.  M.  Rubinow.  'the  medical  profession 
is  the  guardian  of  the  public  health.'  This  view  is  certainly 
not  shared  by  those  who  represent  federal,  state,  county  or 
municipal  health  activities.    Sanitary  science  and  preventive 

^Journal  of  the  American  Medical  Association.  February  IS,  1919,  p.  498, 


3 

medicine  are  fundamentally  separate  and  distinct  from  the 
practice  of  medicine  as  a  healing  art.  It  would  be  a  lament- 
able confusion  of  functions  and  duties  if  the  view  were  to 
gain  general  acceptance  that  the  medical  profession,  as  repre- 
sented by  practicing  physicians  and  surgeons,  is  to  be  con- 
sidered 'the  guardian  of  the  public  health.'  The  contradic- 
tory views  which  are  held  on  these  questions,  and  which  are 
matters  of  fundamental  importance  to  the  general  public,  reach 
their  extreme  in  a  statement  by  Dr.  B.  S.  Warren,  surgeon  of 
the  U.  S,  Public  Health  Service,  that  'The  question  of  health 
is  more  a  matter  of  public  concern  than  the  question  of  educa- 
tion.' " 

Dr.  Frederick  R.  Green,  Secretary,  Council  on  Health  and 
Public  Instruction,  American  Medical  Association,  recently 
said^ : 

"Another  error  into  which  we  have  fallen  as  a  profession 
is  the  tendency  to  regard  the  medical  profession  as  a  divinely 
authorized  class,  whose  sacred  and  distinctive  function  is  the 
protection  of  the  people  either  with  or  without  their  consent. 
It  is  difficult  to  understand  on  what  rational  basis  such  a  be- 
lief can  rest  in  a  scientific  profession  like  ours.  The  medical 
profession  is  recruited  from  the  same  class  as  that  which  fur- 
nishes the  lawyers,  judges,  ministers,  teachers  and  business 
men  of  our  country.  The  men  who  go  into  medicine  are 
neither  wiser,  more  unselfish,  more  upright  or  more  infallible 
in  their  judgment  than  those  who  make  up  any  other  class 
of  professional  men.  Why  should  we  regard  ourselves  as  of 
superior  mold,  or  why  expect  our  opinions  or  views  to  be  ac- 
cepted on  any  different  basis  from  those  of  other  men  of  equal 
intelligence,  except  in  so  far  as  we  are  able  to  justify  our 
judgment?  Yet  too  often  medical  organizations,  as  well  as 
individual  physicians,  have  taken  the  position  that  they  were 
the  courts  of  last  resort ;  that  it  was  their  special  function  to 
dictate  the  terms  of  public  health  legislation,  and  that  it  was 

^Address  before  the  Utah  State  Medical  Association,  Salt  Lake  City.  Utah, 
September  30,  1914,  and  reprinted  by  the  American  Medical  Associa.tion  from 
North  West  Medicine.  December,   1914,  and  January.  1915. 


the  duty  of  the  public  to  accept  their  decisions  and  acquiesce 

in  their  judgment." 

Medical  Teachings  o£  Health  Boards  Create  Fear. — In  a 
paper  on  the  subject  of  "Health  Boards  as  Disturbers  of  the 
Peace"^  Dr.  Charles  Mclntire,  Easton,  Pennsylvania,  calls  at- 
tention to  the  harmful  effects  of  the  alarming  reports  about 
diseases  which  are  sent  out  by  our  health  boards.     He  says : 

"You  are  all  familiar  with  the  Oriental  fable,  where  the 
Cholera  on  his  way  to  Bagdad  informs  a  dervish  in  the  desert 
of  his  intention  of  killing  10,000  people  with  his  plague;  and 
on  returning  from  his  mission  is  met  by  the  same  dervish  who 
accuses  him  of  a  much  higher  death  rate.  The  Cholera 
replied  that  he  had  kept  himself  well  within  his  bounds — the 
excess  was  due  to  fear. 

"Doubtless  if  you  have  not  read,  you  have  all  looked  at 
that  volume  of  goodly  size  by  Daniel  Hack  Tuke  entitled 
'Illustrations  of  the  Influence  of  the  Mind  Upon  the  Body  in 
Health  and  Disease.'  With  the  thought  suggested  by  these 
illustrations  in  mind,  may  not  a  doubt  arise  that  sometimes  our 
health  authorities  in  their  efforts  to  warn,  really  alarm;  wish- 
ing to  awaken,  they  really  affright ;  desiring  to  preserve  peace, 
they  really  disturb  it. 

"I  have  known  in  a  case  of  diphtheria,  where  neither  an 
appeal  to  gratitude  for  past  favors  bestowed,  nor  to  greed  for 
a  present  reward  offered,  was  able  to  secure  any  one  to  per- 
form the  household  duties  for  the  well,  in  a  house  where  the 
proper  isolation  could  be  maintained  in  the  apartments  as- 
signed to  the  ill.  Of  a  husband  who  was  not  able  to  be  with 
his  wife  at  the  deathbed  of  their  son;  she  must  bear  the  strain 
alone,  or  he  would  be  so  quarantined  that,  not  being  subjects 
for  public  support,  the  proper  supplies  could  not  be  brought  to 
the  imprisoned  household.  Of  an  arrangement  by  which  the 
death  of  a  child  would  be  announced  to  a  neighbor  after  the 
manner  of  the  telegraphy  devised  by  the  political  prisoners  in 

'Paper  delivered  before  the  Section  on  State  Medicine — 47th  Annual  Meeting 
of  the  A.  M.  A.  held  at  Atlanta,  Ga.,  May,  1896,  and  published  in  the  Transac- 
tions of  that  Section, 


Russian  fortresses,  as  described  by  Mr.  George  Kennan,  be- 
cause no  one  ventured  beyond  the  door,  on  which  the  dread 
placard  was  placed,  to  do  a  neighborly  deed.  Making  an  in- 
spection for  our  State  Board  of  Health  in  an  outbreak  of 
diphtheria,  I  inquired  as  to  possible  carelessness  in  isolation, 
and  was  told  that  the  simple  announcement  of  the  presence 
of  the  disease  was  enough  to  keep  every  one  away,  regardless 
of  what  might  be  the  ability  of  the  family  to  properly  care 
for  the  suffering.     *     *     *     * 

"I  might  multiply  examples,  but  these  are  enough  for  my 
purpose.  And  I  ask  you  that  if  this  is  the  outcome  of  the 
teachings  of  our  health  boards,  is  it  not  a  fair  inference  that 
one  result  of  these  teachings  is  to  disturb  the  public  peace?" 

An  illustration  of  the  present  tendency  of  our  health  boards 
to  incite  fear  and  thereby  increase  the  prevalence  of  disease 
and  disturb  the  peace  is  furnished  by  the  infantile  paralysis 
scare  a  few  years  ago.  The  following  editorial  comments  by 
newspapers  are  significant: 

The  Brooklyn  (N.  Y.)  Citizen  for  July  8,  1916,  said: 

"The  outbreak  of  infantile  paralysis  is  being  aggravated  by 
the  drastic  measures,  savoring  of  panic,  employed  by  the  health 
and  other  departments  to  convince  the  public  that  they  are 
grappling  with  the  disease.  When  it  is  considered  that  there 
are  several  million  children  in  this  city  and  less  than  seven 
hundred  cases  all  told,  the  'scare'  thrown  into  the  public  by 
the  health  authorities  is  far  from  being  warranted.  This  is 
not  the  first  time  the  city  has  been  visited  by  the  scourge,  which 
is  less  frequent  than  other  infantile  summer  diseases  and  takes 
a  less  heavy  toll  in  deaths.  It  is  endemic  at  all  times  and  like 
certain  other  diseases  becomes  epidemic  at  stated  periods. 
The  best  way  to  conquer  it  is  to  keep  cool.  The  Health  De- 
partment and  other  city  departments  should  set  an  example 
in  this  respect.     What  they  are  doing  is  the  reverse." 

The  New  York  Sun  for  July  16,  1916,  said : 

"The  grossly  exaggerated  notion  that   prevails  here  and 


throughout  the  country  concerning  the  prevalence  of  infantile 
paralysis  in  New  York,  the  hardships  that  have  been  inflicted 
on  the  population,  the  turmoil  that  has  been  caused  all  over 
the  country,  result  from  the  acts  and  words,  not  of  the  news- 
papers, but  of  public  officers  who  lost  their  heads,  or  else  had 
no  heads  to  lose." 

The  Louisville  (Ky.)   Courier- Journal  for  July  15,  1916, 

said: 

'  "We  are  now  having  one  of  those  periodical  panics  into 
which  the  people,  part  of  the  press  and  some  of  the  physicians 
themselves  are  thrown  on  the  appearance  of  the  less  common 
infectious  or  contagious  diseases. 

"Just  now  it  is  infantile  paralysis  that  is  alarming  the  pub- 
lic. Nev/spapers  are  inciting  that  alarm,  while  some  of  the 
men  who  speak  for  medical  science,  and  even  some  who  are 
commissioned  as  health  authorities,  betray  a  notable  ignor- 
ance of  this  particular  malady,  whose  prevention  they  would 
promote  through  measures  no  more  germane  to  infantile 
paralysis  than  to  a  'stumped'  toe. 

"Infantile  paralysis  is  a  horrible  disease,  but  it  is  no  more 
horrible,  while  it  is  less  fatal,  than  several  other  diseases 
which  are  always  preying  on  us  and  about  which  we  concern 
ourselves  very  little  except  when  we  or  some  of  those  near 
to  us  become  their  victims." 

Relation  of  Sanitation  to  Public  Health. — It  is  a  generally 
recognized  fact  that  sanitation  is  largely  responsible  for  the 
reduction  which  has  taken  place  in  epidemic  diseases.  The 
important  role  which  sanitation  plays  in  the  prevention  of  dis- 
ease is  discussed  at  length  in  an  article  recently  appearing  in 
the  Journal  of  the  American  Medical  Association,  by  George 
A.  Soper,  Ph.  D.,  Major,  Sanitary  Corps,  U.  S.  Army,  New 
York.     He  says^ : 

"The  epidemic  diseases  are  disappearing,  probably  not  so 
much  because  of  the  fight  that  is  made  directly  against  them. 


^Journal  of  the  American  Medical  Association,  November  8,  1919,  p.   1406. 


as  on  account  of  indirect  influences  that  bear  on  them.  It 
is  impossible  to  state  with  scientific  accuracy  what  all  of  these 
are  or  exactly  how  they  operate,  but  it  is  possible  that  they 
have  to  do  with  the  higher  standards  of  living  which  prevail. 

"Disease  is  an  ally  of  ignorance,  dirt  and  disorder,  and  it 
everywhere  tends  to  disappear  on  the  improvement  of  knowl- 
edge and  of  social  conditions.  Standards  of  personal,  domestic 
and  municipal  living  are  ever  advancing  and  sweeping  away 
the  opportunities  that  formerly  existed  for  the  spread  of  in- 
fection.    *     *    *     * 

"Sanitary  works  possess  a  number  of  advantages  as  com- 
pared with  other  measures  for  the  prevention  of  disease. 
First,  they  have  a  wholesale  application.  A  water  supply 
that  is  made  pure  is  wholesome  for  every  person  who  has 
occasion  to  drink  it.  Although  there  is  a  considerable  invest- 
ment of  capital  in  these  enterprises,  the  maintenance  charges 
are  not  excessive  and  the  results  are  satisfactory.  Yielding 
to  works  of  sanitation  are  not  only  typhoid,  dysentery  and 
other  diarrheal  diseases,  but  some  other  forms  of  sickness  that 
cannot  conceivably  be  conveyed  by  drinking  water.  This 
phenomenon  has  been  described  in  papers  that  are  so  easily 
accessible  as  to  need  no  repetition  here. 

"It  is  impossible  to  pass  this  point  without  suggesting  that 
the  introduction  of  any  measure  that  materially  contributes 
to  the  cleanness,  convenience  and  order  of  a  community  helps 
to  eliminate  disease,  even  though  its  exact  manner  of  doing  so 
may  not  be  apparent.  Simple  cleanness  is  one  of  the  most 
healthful  as  well  as  one  of  the  most  educative  measures 
known." 

The  opening  of  the  drainage  canal  in  Chicago  is  another 
example  of  the  value  of  sanitation  in  the  reduction  of  disease. 
William  Joseph  Showalter  in  The  National  Geographic  Maga- 
zine for  January,  1919,  says: 

"  'Sic  Semper  Typhoid.' — The  result  of  the  opening  of  the 
drainage  canal  was  phenomenal.     Typhoid,  which  had  reached 


8 

a  degree  of  prevalence  that  was  truly  alarming,  began  to  sub- 
side immediately,  and  Chicago,  but  lately  the  most  unhealth- 
ful  principal  city  in  America,  soon  was  cutting  down  its  death 
rate  faster  than  any  similar  community  anywhere.  No  man 
who  knows  the  history  of  the  conquest  of  water-borne  dis- 
ease by  the  building  of  this  canal  can  fail  to  appreciate  the 
triumph  of  the  sanitarians.  They  said  they  would  cut  the 
t}T)hoid  rate  in  half,  but  they  actually  sHced  off  more  than 
90  per  cent  of  it!" 

Dr.  \lctor  G.  Heiser,  Director  for  the  East,  International 
Health  Board  of  the  Rockefeller  Foundation,  also  attributes 
t}'phoid  and  other  intestinal  diseases  to  insanitation.  Refer- 
ring to  typhoid,  hookworm  infection,  diarrhea,  dysentery, 
cholera,  and  other  intestinal  diseases,  Dr.  Heiser  says^ : 

"It  may  be  well  to  ask  what  can  be  done  to  prevent  this 
enormous  waste.  The  answer  is  simple.  It  is  only  necessary 
to  provide  for  the  safe  disposal  of  the  excrement  of  the  entire 
population.  In  most  of  our  cities  the  problem  has  been  largely 
solved  through  the  water  carriage  of  sewage.  Yet,  even  in 
Philadelphia,  there  are  thousands  of  open  privies  which  may 
be  a  menace  to  health  through  the  agency  of  flies  and  other 
sources  of  contact  which  may  cause  contamination  of  human 
food  and  drink." 

Relation  of  Higher  Living  Conditions  to  Public  Health. — 
Higher  living  conditions  is  another  factor  which  must  be 
taken  into  consideration  in  pubHc  health  work.  In  a  report  of 
a  subcommittee  of  the  state-wide  tuberculosis  committee, 
which  was  appointed  by  Governor  Goldsborough  of  Mar^dand 
and  published  in  the  Baltimore  American,  January  15,  1916, 
it  is  recommended  that  more  attention  be  given  to  higher  liv- 
ing conditions  in  the  campaign  against  tuberculosis.     It  says : 

"Reliable  studies  inform  us  that  90  per  cent  of  the  human 
race  is  tuberculosis  infected,  and  that  infection  occurs  at  a 


^Article    in    The    Annals    of    the    American    Academy    of    Political    and    Social 
Science.  July,   1918.  p.   48. 


very  early  stage,  so  that  at  12  years  few  children  have  escaped 
it.  Relatively  a  small  number  of  those  infected  sul)sequently 
become  tuberculous  so  that  something  more  than  irifection  is 
necessary  for  tuberculosis  to  develop.  What  this  something 
is  we  do  not  know. 

"Higher  Living  Standards" 

"Here  is  the  field  for  wide  social  activity.  Everything  that 
makes  for  higher  standards  of  living  and  for  improved  per- 
sonal hygiene  is  a  valuable  arm  against  tuberculosis.  Housing 
laws,  child-labor  laws,  the  wage  question,  municipal  recreation 
centers,  the  liquor  question,  social  service  in  all  its  depart- 
ments, vacation  lodges,  open-air  schools,  factory  inspection, 
and  so  on  are  all  indirectly  reliable  anti-tuberculosis  agitation  " 

Relation  of  Family  Income  to  Public  Health. — The  rela- 
tion of  poverty  to  a  high  morbidity  and  mortality  rate  has  been 
the  subject  of  numerous  investigations,  all  of  which  indicate 
that  progress  toward  the  elimination  of  disease  depends  largely 
upon  the  family  income. 

The  Bulletin  of  the  Kansas  State  Board  of  Health  for  Aug- 
ust-September, 1918  commented  as  follows  upon  a  publication 
by  the  Children's  Bureau,  Washington,  D.  C.  entitled  "Studies 
in  Infant  Mortality" : 

"The  infant  mortality  rate  shows  a  marked  and  almost  regu- 
lar decline  as  the  father's  earnings  become  larger.  For  the 
group  of  babies  in  which  the  father's  earnings  are  less  than 
$450  per  annum,  the  infant  mortality  rate  is  243.9  per  1,000 
live  births,  while  in  the  next  group,  in  which  the  father  earns 
from  $450  to  $549,  the  rate  is  173.6.  It  rises  very  slightly  in 
the  next  class  $550  to  $649  to  174.5,  and  thereafter  drops 
steadily  with  each  advance  in  economic  status.  The  rate,  how- 
ever, does  not  fall  below  100  until  the  father's  earnings  reach 
$1,050  or  more.  Babies  whose  fathers  earn  $1,250  and  over 
per  annum  have  a  death  rate  of  only  58.3." 


10 

The  following  is  from  the  report  of  a  recent  investigation 
by  representatives  of  the  United  States  PubUc  Health  Service  :^ 

"To  what  extent  low  family  income  was  a  cause  of  higher 
sickness  rate  and  to  what  extent  it  was  an  effect  of  disability 
(and  thus  of  inability  to  increase  income)  can  not,  of  course, 
be  determined  from  these  data.  The  condition,  however,  is 
manifest  that  a  greater  amount  of  disabling  sickness  existed 
among  persons  who  were  living  under  less  favorable  economic 
conditions  than  among  persons  whose  economic  status  was 
more  favorable — a  condition  which  has  been  pointed  out  by 
previous  observations  in  the  literature  on  the  social  aspects 
of  ill  health  and  indicated  by  several  recent  studies  (a).  The 
data  here  presented  afford  additional  ground  for  the  sugges- 
tion that  in  the  analysis  of  morbidity  facts  the  factor  of  eco- 
nomic status  should  be  given  proper  emphasis." 

"(a)  For  example,  physical  examinations  of  garment  work- 
ers in  the  cloak,  suit,  and  shirt  industry  in  New  York  City  in 
1914  showed  that  while  'no  vocational  diseases  peculiar  to 
garment  workers'  were  found,  the  condition  was  'clearly  sug- 
gested .  .  .  that  the  greatest  number  of  poorly  nourished, 
anemic  tuberculous  workers  in  an  extremely  seasonal  indus- 
try were  in  that  group  composed  of  the  lowest  paid  and  the 
least  regularly  employed.'  (Health  of  Garment  Workers — 
The  Relation  of  Economic  Status  to  Health,  by  B.  S.  War- 
ren, surgeon,  and  Edgar  Sydenstricker,  public  health  statis- 
tician, with  an  introduction  by  J.  W.  Schereschewsky,  surgeon, 
U.  S.  Public  Health  Reports,  May  26,  1916,  pp.  1298-1305, 
Reprint  No.  341.)  Reference  may  also  be  made  to  the  re- 
cent reports  of  infant  mortality  studies  conducted  in  various 
communities  by  the  Children's  Bureau  of  the  U.  S.  Depart- 
ment of  Labor;  to  the  studies  of  John  Robertson,  M.D.,  in 
Birmingham,  England;  and  to  others." 


^"Disabling  Sickness  Among  the  Population  of  Seven  Cotton  Mill  Villages  of 
South  Carolina  in  Relatioa  to  Family  Income,  by  Edgar  Sydenstricker,  Public 
Health  Statistician ;  G.  A.  Wheeler,  Assistant  Surgeon ;  and  Joseph  Goldberger, 
Surgeon.  V.  S.  Public  Health  Service,  published  in  "Public  Health  Reports," 
U     S.   P^h-iic  Health  S/M-vica.  2^ ovfjrtheT  22    1918,  p.   2051. 


11 

VV.  C.  Gorgas,  formerly  Surgeon-General,  U.  S.  Army,  re- 
cently said:^ 

"Before  these  great  results  that  we  can  all  now  see  are 
possible  for  the  sanitarian,  we  shall  have  to  alleviate,  more 
or  less,  the  poverty  at  present  existing*  in  all  civilized  com- 
munities. Poverty  is  the  greatest  of  all  breeders  of  disease, 
and  the  stone  wall  against  which  every  sanitarian  must  im- 
pinge    ..." 

Analysis  of  Appropriations  for  Alleged  Public  Health 
Purposes. — An  analysis  of  the  appropriations  now  being 
made  by  our  city,  state  and  Federal  health  activities  shows  that 
sanitary  engineering  and  other  fundamental  health  problems 
are  not  being  given  the  attention  which  they  deserve  by  our 
government  health  activities  while  vast  appropriations  are  be- 
ing spent  for  medical  purposes. 

The  Pennsylvania  Board  of  Health,  for  example,  out  of  a 
total  biennial  appropriation  of  $5,251,604  spends  $3,384,180 
for  tuberculosis  work  and  $225,000  for  school  inspection. 
The  following  is  an  itemized  statement  of  the  appropriations 
for  the  Pennsylvania  Board  of  Health  for  the  biennial  period 
ending  May  31,  1919,  as  published  in  "Public  Health  Reports," 
October  18,  1918,  p.  1781: 

"Tuberculosis  work  $3,384,180 

"General  fund  1.075,000 

"School  inspection   225,000 

"Salaries  567,424 


$5,251,604" 


The  California  Board  of  Health  out  of  a  total  appropriation 
of  $616,800  only  spends  $50,000  biennially  or  $25,000  annually 
for  sanitary  engineering  and  $65,000  biennially  for  pure  food 


^Address  by  Former  Surgeon- General  W.  C.  Gorgas,  before  the  Clinical  Society 
of  Surgeons,  Washington,  D.  C,  as  published  in  a  communicatiion  appearing  in 
The  Philadelphia  Bulletin,  January,  1919. 


1» 

and  drug^s.  The  appropriations  for  the  California  Board  of 
Health  for  the  biennial  period  ending  June  30,  1921,  as  pub- 
lished in  "Public  Health  Reports,"  July  25,  1919  are  as  fol- 
lows: 

"Traveling  and  contingent  expenses $  42,000 

"Tuberculosis  control  work 200,000 

"Pure  food  and  drugs  65,000 

"Hygienic  laboratory  and  antirabic  virus....  50,000 

"Stenographic  services  2,400 

■    "Printing   8,000 

"Contagious  diseases  55,000 

"Sanitary  engineering 50,000 

"Statutory  salaries  (from  general  appro- 
priation)      47,800 

"Support  of  6  district  health  officers,  at 

$3,000,  expenses,  etc 25,000 

"Venereal  disease  control  work  51,600 

"Child  Hygiene  20,000 


$616,800" 


The  Massachusetts  Board  of  Health  spends  more  for  the 
production  and  distribution  of  antitoxin  and  vaccine  and 
arsphenamine  than  it  does  for  the  Division  of  water  supply 
and  sewage  disposal.  Its  appropriations  for  the  fiscal  year 
ending  November  30,  1919,  as  given  in  "Public  Health  Re- 
ports," July  25,  1919,  p.  1632,  are  as  follows: 

"Division  of  administration  $  28,700 

"Division  of  hygiene  27,850 

"Division  of  communicable   diseases   101,350 

"Production  and  distribution  of  antitoxin 

and  vaccine  50,300 

"Manufacture    and    distribution    of    ars- 
phenamine     19,200 

"Division  of  food  and  drug  inspection  34.000 


13 

"Division  of  water  supply  and  sewage  dis- 
posal   „ 65,000 

"State  examiners  of  plumbers  4,800 

"An  investigation  relative  to  causes,  treat- 
ment and  prevention  of  cancer  3,000 

$334,200" 


CHAPTER  II 

DEVELOPMENT  OF  AND  PLAN  FOR  STATE 
MEDICINE 

"Every  encroachment,  great  or  small,  is  important  enough  to 
awaken  the  attention  of  those  who  are  entrusted  with  the  preserva- 
tion of  a  constitutional  government.  We  are  not  to  wait  till  great 
public  mischiefs  come,  till  the  government  is  overthrown,  or  lib- 
erty itself  put  into  extreme  jeopardy.  We  should  not  be  worthy 
sons  of  our  fathers  were,  we  so  to  reg'ard  great  questions  affecting 
the  general  freedom." — Caniel  Webster,  in  an  Address  in  the  Sen- 
ate, May  7,  1834,  as  quoted  in  "Medical  Freedom,"  May,  1912. 

THE  term  "State  Medicine,"  as  used  by  the  author,  is 
almost  synonymous  with  the  term  "Compulsory  Allo- 
pathic Medicine"  but  does  not  include  the  exercise  of  func- 
tions by  the  Government  of  a  purely  sanitary  character. 

Compulsion  the  Key-Note. — ^The  following  extracts  from 
an  address  by  Dr.  Samuel  Dixon,  formerly  Commissioner  of 
Health  of  Pennsylvania,^  are  given  to  show  the  prominence  of 
the  element  of  compulsion  in  the  campaign  for  state  medicine : 

"COMPULSION  NOT  PERSUASION  THE  KEY- 
NOTE OF  STATE  MEDICINE.— Let  it  be  under- 
stood at  the  outset,  however,  that,  no  matter  how 
great  efforts  we  may  make  to  educate  the  people, 
unless  we  have  the  lex  scripta,  the  written  law,  to  fall 
back  on,  state  medicine,  while  it  may  be  a  beautiful  science, 
can  never  be  a  practical  art  .  .  .  the  laws  we  must  have. 
These  laws  must  reach  into  all  the  relations  of  human  life. 

.  .  .  Thus  we  have  a  state  system  of  sanitary  adminis- 
tration complete  and  symmetrical,  its  head  at  the  seat  of  power 

^Address  entitled  "Law,  the  Foundation  of  State  Medicine,"  by  Samuel  G. 
Dixon,  M.  D.,  before  the  American  Medical  Association,  Atlantic  City,  June, 
1907,  and  published  in  the  Journal  of  the  American  Medical  Association,  June  8, 
\907,  p.    1926. 


15 

in  the  state,  untrammeled  in  the  exercise  of  authority,  reaching 
down  through  the  subdivisions  of  county  and  township  to  the 
people ;  and  a  department  in  daily  touch  with  every  nook  and 
corner  of  the  state  through  its  faithful  allies,  the  physicians 
of  the  commonwealth." 

The  Term  "State  Medicine"  Defined. — Paraphrasing  the 
last  sentence  of  the  above  quotation,  the  term  "State  Med- 
icine" may  be  defined  as  "A  state  (or  Federal)  system  of 
administration  of  compulsory  allopathic  medicine,  complete  and 
symmetrical,  its  head  at  the  seat  of  power  in  the  state  (or 
Federal  Government),  untrammeled  in  the  exercise  of  author- 
ity, reaching  down  through  the  subdivisions  of  county  and 
township  to  the  people ;  and  a  department  in  daily  touch  with 
every  nook  and  corner  of  the  state  or  nation  through  its 
allies,  the  (allopathic)  physicians  of  the  state  or  nation." 

Domination  of  Public  Health  Activities  by  Physicians. — 
The  state  boards  of  health  are  dominated  almost  entirely  by 
physicians.  Attention  was  called  to  this  subject  by  Morris 
Knowles,  C.  E.  in  an  address  September,  1912,  in  which  he 
said  :* 

"In  fifteen  states  all  members  of  the  state  boards  of  health 
(leaving  out  one  or  two  ex-officio  members,  as  governors  and 
attorney  generals,  in  a  few  cases)  are  required  to  be  physi- 
cians. Twenty-three  states  require  one  or  more,  but  not  all 
members  of  the  state  board  of  health  to  be  physicians.  In  ten 
states  there  is  no  professional  requirement  for  eligibility. 

"Out  of  46  executive  officers  of  state  boards  of  health  (var- 
iously called  commissioners,  secretaries,  superintendents,  pres- 
idents and  state  health  officers)  32  must  be  physicians  and  14 
have  no  such  requirement. 

"Alabama,  the  first  in  the  alphabetical  roll  of  states,  will 


^Address  by  Morris  Knowles,  C.  E.,  Director,  Department  of  Sanitary  Engineer- 
ing, University  of  Pittsburgh,  Pa.,  Before  the  Sanitary  Engineering  Section, 
American  Public  Health  Association,  Washington,  D.  C,  September,  1912,  and 
published  in  the  American  Journal  oi  Public  Health.  February.   J91.1 


16 

be  given  more  detailed  consideration  for  the  sole  reason  that 
it  is  believed  to  represent  the  best  example  of  the  medical 
monopoly  fallacy  carried  to  its  ultimate  limit.  Under  the  pres- 
ent law  in  Alabama,  first  enacted  in  1875,  and  amended  sev- 
eral times  since,  the  Alabama  Medical  Association  is  legally 
constituted  the  State  Board  of  Health.  This  association,  with 
a  membership  of  over  eighteen  hundred  physicians,  meets  once 
a  year  and  elects  an  executive  officer,  known  as  the  state  health 
officer,  who,  with  the  State  Committee  of  Public  Health  (the 
Board  of  Censors  of  the  Medical  Association)  supervises  and 
directs  the  administration  of  the  public  health  laws  of  the 
state,  during  intervals  between  meetings  of  the  association." 

The  Directory  of  State  and  Insular  Health  Authorities  con- 
tained in  "Public  Health  Reports"  July  25,  1919  shows  that 
out  of  a  total  of  fifty-three  states  and  insular  possessions  given 
the  executive  officer  of  the  state  or  insular  health  authority 
is  an  "M.D."  in  all  but  three  of  them. 

Our  state  health  authorities  are  not  only  manned  almost 
entirely  by  allopathic  physicians  but  the  same  is  true  of  our 
Federal  and  local  health  activities. 

According  to  the  By-Laws  of  the  American  Medical  Asso- 
ciation, the  leading  organization  of  allopathic  physicians  in 
this  country,  "Commissioned  Medical  officers  of  the  United 
States  Army,  United  States  Navy  and  the  United  States  Pub- 
lic Health  Service  shall  be  Fellows"  of  the  American  Med- 
ical Association  "so  long  as  they  are  engaged  actively  in  their 
respective  service  and  thereafter  if  they  have  been  retired  on 
account  of  age  or  physical  disability." 

So  closely  is  the  American  Medical  Association  allied  with 
the  Federal  health  activities  that  in  1916  Dr.  Rupert  Blue, 
while  Surgeon-General  of  the  United  States  Public  Health 
Service,  became  President  of  the  American  Medical  Associa- 
tion, and  at  the  Annual  Meeting  of  the  American  Medical  As- 
sociation June  9-13,  1919  Rear-Admiral  William  C.  Braisted, 
Surgeon-General,  United  States  Navy,  became  President-Elect 
of  that  association. 


ir 

Laws  and  Regulations  Now  in  Force. — The  laws,  rules 

and  ordinances  providing  for  our  public  health  activities,  as 
previously  referred  to,  discriminate  in  favor  of  allopathic 
physicians,  theories  or  practices. 

Medical  Practice  Acts  have  been  passed  in  a  number  of 
states  tending  to  restrict  the  practice  of  the  healing  art  to  one 
school  of  medicine.  These  acts  are  discussed  at  length  in 
another  chapter. 

A  number  of  states  make  either  vaccination,  medical  exam- 
inations or  the  teaching  of  subjects  related  to  medicine  a 
requisite  for  obtaining  an  education  in  the  public  schools. 

Four  states,  Oregon,  Wisconsin,  North  Dakota  and  Ala- 
bama have  passed  laws  requiring  a  medical  certificate  of  male 
applicants  for  a  marriage  license. 

Laws  providing  for  the  sterilization  of  criminals  in  certain 
cases  have  been  passed  in  Connecticut,  New  Jersey,  Indiana, 
Iowa,  Washington,  California,  New  York,  Nevada,  Michigan, 
Kansas  and  Wisconsin.  The  law  which  was  passed  in  Iowa 
has  been  declared  unconstitutional. 

Vaccination  against  smallpox,  typhoid  and  paratyphoid  is 
compulsory  in  .the  United  States  Army  and  Navy. 

One  of  the  requirements  for  a  commission  in  the  Medical 
Corps  of  the  Army  is  that  the  applicant  shall  be  an  "M.D." 

Charles  E.  Simon,  M.D.  in  a  recent  book  entitled  "Human 
Infection  Carriers"  gives  various  rules  and  regulations  of  state 
boards  of  health  and  the  laws  on  the  subject  of  "carriers" 
prior  to  January  1,  1918.  Two  states,  Minnesota  and  New 
York,  have  laws  specifically  referring  to  "carriers."  The  law 
in  New  York  is  especially  drastic. 

Styles  in  Medical  Legislation. — ^The  passage  of  so-called 
public  health  laws  in  some  states  has  been  characterized  as 
keeping  up  with  the  styles  rather  than  an  attempt  to  meet  the 
needs  of  the  particular  state.  In  this  connection  Frederick  R. 
Green,  M.D..  Secretary  Council  on  Health  and  Public  Instruc- 
tion, American  Medical  Association,  recently  said:* 


*In  an  article  appearing  in  The  Survey,  September  27,   1913. 


18 

"It  may  seem  ridiculous  to  talk  about  fashions  in;  public 
health  laws.  Yet  careful  observation  will  confirm  the  fact  that 
legislative  efforts  are  prone  to  run  in  certain  grooves  at  cer- 
tain times.  Two  years  ago,  every  legislature  that  met  was 
considering  bills  for  the  abolition  of  common  drinking  cups 
and  roller  towels.  This  year  the  styles  have  changed.  Bills  for 
the  sterilization  of  criminals,  the  regulation  of  marriage,  and 
the  medical  inspection  of  schools  have  been  the  most  gen- 
erally considered,  and  this  regardless  of  the  peculiar  charac- 
teristics and  needs  of  the  particular  state.  For  instance,  in  a 
western  state  with  a  sparse  and  scattered  population,  few  large 
towns,  a  single  penitentiary,  an  insane  asylum  with  few  in- 
mates, and  no  public  health  organization  worth  mentioning, 
the  legislature  considered  a  bill  for  the  sterilization  of  crim- 
inals, not  because  of  present  need  for  such  a  law,  but  to  keep 
in  line  with  other  states." 

PROPOSED  LEGISLATION  MAKING  STATE  MED- 
ICINE MORE  COMPLETE 

Efforts  to  Secure  National  Department  of  Health. — For 

a  quarter  of  a  century  and  more  the  American  Medical  Asso- 
ciation has  carried  on  a  vigorous  campaign  for  the  establish- 
ment of  a  National  Department  of  Health.  The  ostensible 
purpose  of  such  a  department  is  to  promote  the  health  of  the 
nation. 

It  has  frequently  been  pointed  out,  however,  that  if  a  Na- 
tional Department  of  Health  were  established  its  power  would 
be  abused  and  that  it  would  be  used  by  those  in  control  in  an 
effort  to  establish  a  monopoly  in  the  healing  art  and  to  secure 
the  medical  control  of  the  citizen. 

This  contention  is  borne  out  by  the  following  extracts  from 
the  Presidential  Address  of  Dr.  J.  W.  Van  Derslice  before 
the  Illinois  State  Medical  Society  recently:^ 

^Address   by   Dr.   Van    Derslice   before    the   Illinoiis    State   Medical    Society,   at 
Rockford,  May  19,   1920,  as  reported  in  the  Illinois  Medical  Journal,  June,   1920, 
pp.   373-378. 


19 

"The  medical  profession  of  this  country  has  given  organ- 
ized and  individual  effort  toward  the  creation  of  a  United 
States  Department  of  Health.  To  this  idea  all  have  sub- 
scribed; this  largely,  first,  because  it  appealed  to  our  vanity; 
second,  because  many  prominent  members  of  the  profession 
approved  it.  Nevertheless,  the  safety  to  the  profession  de- 
pends wholly  upon  the  attitude  of  the  recipient  of  the  ofhce. 

"For  example,  the  aim  of  some  of  the  advocates  of  this  ven- 
ture is  that  the  department  regulate  the  practice  of  medicine 
and  allied  professions;  supervise  all  state  departments  of 
health;  all  state  institutions,  hospitals  and  dispensaries;  that 
all  candidates  to  enter  the  study  of  medicine  expecting  to  re- 
ceive state  appointment  shall  first  secure  a  certification  of  fit- 
ness from  said  department  and  only  to  enlist  such  number  as 
the  service  shall  annually  require;  in  other  words  build  up 
the  same  political  institution  as  West  Point;  to  fix  a  health 
standard  above  the  minimum  of  which  individuals  are  to  be 
considered  well;  to  have  periodic  physical  examinations  of 
every  individual  in  the  state;  the  establishment  of  compulsory 
treatment,  without  limitation,  other  than  recovery  or  death,  of 
those  compulsorily  examined  and  found  to  be  below  the  mini- 
mum standard  of  health  and  of  those  taken  sick;  a  compul- 
sory sickness  insurance  system  to  provide  funds ;  the  insurance 
premiums  and  payments  to  be  determined  along  actuarial  lines. 
Here  is  the  embodiment  of  the  defeated  New  York  measure 
dressed  out  in  new  attire  to  be  foisted  upon  an  unsuspecting 
profession  by  the  establishment  of  a  national  department  of 
health. 

*     *     * 

"That  the  above  picture  is  not  greatly  overdrawn  as  to  the 
activities  desired  by  those  now  in  authority  in  the  government 
public  health  service  is  evidenced  by  the  many  bills  that  have 
been  introduced  in  Congress  in  which  the  various  states  were 
to  receive  government  subsidies  when  these  states  agreed  to 
act  conjointly  with  the  Public  Health  Service. 

"There  is  to  be  a  very  definite  attempt  to  secure  a  national 


30 

department  of  health  in  the  near  future.  Before  giving  the 
endorsement  of  the  organization  to  this  venture  a  little  caution 
should  be  exercised  to  see  what  safeguards  there  are  to  be 
against  state  medicine." 

The  Constitution,  however,  does  not  charge  the  Federal 
Government  with  the  guardianship  of  the  public  health  but 
leaves  that  duty  to  the  police  powers  of  the  states  and  local 
authorities.  Furthermore,  a  National  department  of  Health 
is  not  needed  because  there  are  already  constituted  authorities 
of  unquestioned  power  and  right  to  attend  to  such  health  mat- 
ters as  come  within  the  jurisdiction  of  the  Federal  Govern- 
ment as  indicated  by  the  following  citations  from  widely 
known  medical  writers. 

Dr.  Henry  B.  Hemenway  of  Evanston,  Illinois  in  an  ad- 
dress before  the  section  on  "Preventive  Medicine  and  Public 
Health"  of  the  American  Medical  Association,  June,  1909, 
said  :* 

"In  the  United  States  the  national  government  has  only  such 
powers  as  were  conferred  on  it  by  the  people  of  the  several 
states.  Essentially  the  state  is  supreme,  and  there  are  reserved 
to  it  by  the  tenth  amendment  to  the  Constitution  all  those  powers 
not  given  to  the  nation  or  prohibited  by  the  Constitution  to  the 
state.  The  only  authority  of  a  sanitary  nature  which  the 
nation  has  must  be  found  in  the  regulation  of  commerce.  We 
frequently  hear  the  suggestion  that  the  national  government 
ought  to  pass  a  law  regulating  the  practice  of  medicine,  for 
example,  so  that  the  requirements  might  be  uniform  in  all 
parts  of  the  land;  and  to  make  transfers  from  state  to  state 
less  troublesome.  Though  such  a  law  might  be  desirable,  as  a 
practical  fact  it  is  at  present  impossible,  for  the  simple  reason 
that  Congfress  has  no  power  to  pass  such  an  act. 

*     *    * 

"The  authority  of  the  states  to  pass  health  laws,  as  in  op- 
position to  the  power  of  Congress  to  regulate  commerce,  has 


^''The  Limitations  in   Public  Health  Administration,"  by  Dr.   Hemenway,  pub- 
lished in  the  Journal  of  the  American  Medical  Association,  August  28,  1919. 


21 

been  discussed  in  many  cases  before  the  Supreme  Court  of  the 
United  States,  and  whenever  it  has  appeared  that  the  statutes 
or  regulations  have  been  really  in  the  interest  of  health  the 
authority  of  the  state  has  been  sustained." 

Allan  J.  McLaughlin,  Assistant  Surgeon-General,  United 
States  Public  Health  Service,  recently  said:^ 

"Police  power  has  been  given  very  sparingly  to  Federal 
health  authorities  and  delegated  by  States  in  large  measure  to 
local  authorities  because  the  ultimate  appHcation  of  poHce 
power  to  the  individual  citizen  logically  belongs  to  the  agency 
with  which  he  is  in  direct  contact,  viz.,  the  local  board  of 
health.     *     *     *     * 

"I  hope  I  have  made  it  clear  that  the  only  need  of  the  Pub- 
lic Health  Service  is  sufficient  money  to  carry  out  its  pro- 
grams. 

"The  service  now  possesses  all  the  authority  and  function 
which  can  be  given  by  Congress  to  a  Federal  Health  agency 
within  the  limits  of  the  Constitution." 

In  an  address  at  Chicago  Dr.  Victor  C.  Vaughan,  formerly 
President  of  the  American  Medical  Association,  declared:^ 

"The  exercise  of  medical  functions,  whether  the  regulation 
of  medical  practice  or  preventive  medicine,  is  under  state  con- 
trol, and  I  think  it  is  rather  fortunate  that  this  is  the  case, 
because,  divided  as  we  are  into  forty-eight  political  groups, 
we  do  not  have  to  make  the  same  experiments  at  the  same 
time." 

The  unwarranted  expenses  of  such  a  department  would  be 
enormous,  thereby  increasing  the  taxes  necessary  to  maintain 
the  Federal  Government.  According  to  Prof.  Irving  Fisher, 
an  advocate  of  such  a  department,  it  is  a^  "project  which, 
once  started,  will  surely  expand  within  a  decade,  so  that  mil- 


iln   an   article   in   "Public   Health  Reports,"   September  26,  1919,   pp.   2144-2147. 

^Chairman's  Address  before  Conference  on  Public  Health  and  Legislation, 
reported  in  The  Journal  of  the  American  Medical  Association,  April  3,  1920, 
p.  973. 

^From  letter  quoted  by  Senator  Smoot  in  Hearings  before  the  Committee  on 
Public  Health  and  National  Quarantine,  United  States  Senate,  on  the  Bill  S. 
6049  "To  Establish  a  Department  of  Health  and  for  other  Purposes,"  April  29, 
1910,  Part  1,  p.  i,l. 


22 

lions  upon  millions  of  government  money"  will  be  at  its  serv- 
ice. 

Compulsory  Health  Insurance  Proposed. — The  first  or- 
ganized effort  in  the  United  States  for  the  establishment  of 
compulsory  health  insurance  legislation  was  five  or  six  years 
ago  when  the  so-called  American  Association  for  Labor  Leg- 
islation sent  out  thousands  of  copies  of  "A  tentative  Draft  of  a 
Bill."  The  next  year  the  so-called  Mills  Bill  was  introduced 
•in  the  New  York  Legislature.  The  following  year  a  similar 
bill  was  introduced,  but  did  not  come  out  of  the  committee. 

Efforts  were  then  made  to  secure  the  appointment  of  com- 
missions. Ten  states  passed  bills  of  this  kind,  but  the  findings 
of  the  commissions  for  the  most  part  have  been  against  the 
adoption  of  compulsory  health  insurance. 

An  amendment  empowering  the  Legislature  to  enact  laws 
on  the  subject  of  compulsory  health  insurance  was  defeated  in 
California  by  a  vote  of  three  to  one.  The  amendment  did  not 
carry  in  a  single  county  in  the  state,  showing  that  the  people 
generally  are  strongly  opposed  to  the  adoption  of  compulsory 
health  insurance. 

Seek  Medical  Control  of  Children. — Laws  providing  for 
medical  examination  of  children  in  the  public  schools  affords 
another  means  of  extending  state  medicine  and  has  been  urged 
as  a  new  field  for  professional  medical  activity.  Even  as  far 
back  as  1898  before  the  propaganda  for  medical  school  in- 
spection had  gained  much  headway  in  this  country,  the  Jour- 
nal of  the  American  Medical  Association  for  October  39  said : 

"It  ought  to  be  welcome  news  that  a  new  field  is  opening 
up  for  our  professional  activity  .  .  .  Any  new  outlet  for 
our  energies  will  help  to  either  postpone  that  dies  irae  or  to 
mitigate  its  horrors  when  it  does  arrive.  And  we  wish  to 
seriously  call  the  attention  of  the  profession  to  the  fact  that 
there  is  opening  up  before  us  today  in  the  schoolroom  an 
almost  entirely  new  field  of  usefulness,  one  which  could  profit- 
ably absorb  the  entire  energies  of  one-third  of  our  present 
membership     ..." 


23 

Closely  allied  with  the  proposals  for  the  employment  of  a 
vast  number  of  physicians  by  the  Government  to  examine 
children  in  the  public  schools  comes  the  demand  for  the  com- 
pulsory teaching  of  certain  medical  subjects  in  the  schools. 
Little  by  little  an  effort  is  being  made  to  bring  about  the  med- 
ical domination  of  the  schools  and  the  children  attending 
them. 

Bill  for  Card-Indexing  Everybody. — If  further  evidence 
is  needed  to  show  that  there  exists  a  well -laid  plan  to  med- 
ically enslave  the  nation,  attention  is  called  to  a  bilP  intro- 
duced in  the  United  States  Senate  recently  by  Senator  Joseph 
I.  France  of  Maryland  providing  for  the  card-indexing  of 
everybody. 

This  bill  provides  that  the  President  shall  specify  and  pub- 
licly proclaim  "Census  Enumeration  Days"  at  which  times  all 
of  the  inhabitants  of  each  census  precinct  shall  go  to  the  ofiice 
of  the  census  precinct  in  person  or  through  the  head  of  thje 
family,  parent,  teacher,  or  head  of  the  firm  by  which  he  may 
be  employed,  to  be  enrolled  and  to  receive  a  numbered  regis- 
tration card. 

The  director  of  the  Census  shall  make  regulations  concern- 
ing the  carrying  by  individuals  of  identification  numbered 
registration  cards. 

The  bill  provides  for  "an  annual  medical  examination"  of 
"all  school  children  under  fourteen  years  of  age  and  of  all 
males  under  forty-five  years  of  age." 

All  persons  under  the  bill  are  to  be  card-indexed  and  dupli- 
cate cards  kept  containing  information  as  to  the  person's 
health  and  physical  condition ;  any  acute  or  chronic  diseases 
which  the  person  may  have  had ;  school  attendance  and  prog- 
ress ;  trade ;  business ;  public  offices ;  honors  or  special  achieve- 
ments; payment  of  taxation  or  insurance  premiums;  whether 
qualified  and  exercising   right  to  vote ;   literacy  of  parents ; 


_^*S.2616,  "To  repeal  and  reenact  certain  sections  of  'An  act  to  provide  for  the 
Fourteenth  and  subsequent  decennial  censuses.'  introduced  by  Senator  Joseph  I. 
France,  July  24,  1919. 


34 

cause  of  death ;  and  many  other  things  too  numerous  to  men- 
tion. 

Sponsors  of  Legislation  for  State  Medicine. — ^The  average 
medical  practitioner  directs  his  attention  to  his  efforts  to  re- 
lieve the  suffering  of  humanity.  It  is  not,  however,  the 
average  practitioner  who  is  advocating  state  medicine.  It  is, 
on  the  contrary,  the  medical  organizer — the  medico-politician 
— who  displaces  his  busy  and  silent  brother  before  the  public, 
presumes  to  represent  him,  and  becomes  the  recognized  spokes- 
man for  "the  medical  profession."  He  it  is  who  formulates 
its  public  utterances,  engineers  with  amazing  deftness  its 
propaganda  through  the  newspapers,  clubs  and  public  organi- 
zations, drafts  its  legislative  bills,  declares  to  legislators  and 
the  public  "the  profession's"  aims  and  wishes,  and  engineers 
its  public  activities  generally  "in  the  name  of"  The  Medical 
Profession. 

The  agitation  for  most  of  the  legislation  that  would  be 
included  under  the  term  "State  Medicine"  owes  its  origin  to 
the  American  Medical  Association,  an  orgaruzation  chiefly 
composed  of  allopathic  physicians,  with  its  headquarters  at 
Chicago. 

This  association  cannot  speak  for  the  Homeopathic  physi- 
cians, the  Eclectic  physicians,  the  Osteopathic  physicians;  the 
Christian  Scientists,  the  Chiropractors,  the  Naturopaths  and 
numerous  other  groups  of  practitioners,  each  of  which  have 
their  respective  organizations.  It  can  only  speak  for  a  portion 
of  the  allopathic  physicians  coming  within  the  scope  of  the 
organization.  Needless  to  say,  a  large  part  of  the  allopathic 
physicians  are  opposed  to  the  present  tendency  toward  state 
medicine.  This  is  especially  true  of  compulsory  health  in- 
surance, numerous  medical  societies  having  taken  a  very  posi- 
tive stand  in  opposition  to  this  proposed  innovation. 

The  American  Medical  Association  came  into  existence  in 
May,  1S47.  During  the  first  years  of  its  history  its  activities 
were  directed  along  channels  that  might  be  regarded  as  com- 


2?) 

mendable.  But  gradually  as  it  grev^  in  membership  and  power 
it  has  sponsored  a  legislative  program  that  would,  if  adopted, 
mean  the  medical  control  of  everybody.  A  number  of  phy- 
sicians and  medical  journals,  including  the  following,  have 
commented  upon  how  closely  the  American  Medical  Associa- 
tion was  organized. 

In  an  editorial  under  the  title  "Organization  Gone  Mad" 
the  Lancet-Clinic,  a  well-known  medical  publication  of  Cin- 
cinnati, in  its  issue  for  February  18,  1911  said: 

"The  American  Medical  Association  is  perhaps  the  best 
illustration  of  the  effect  of  the  organization  furore.  It  has 
become  to  all  intents  and  purposes  a  huge  oligarchy.  Its  pol- 
icies are  directed  by  a  few  who,  ostensibly  acting  as  the  agents 
of  the  members,  in  reality  take  the  initiative  in  every  move- 
ment, assisted  thereto  by  the  constitution  of  the  society  itself. 
The  spirit  of  democracy  is  as  foreign  to  it  as  it  is  in  the  realm 
of  the  Czar  of  all  the  Russias.  It  is  the  natural  result  of  the 
modern  trend  of  concentration,  subordinating  private  judg- 
ment to  the  leaders'  dictum. 

"We  see  the  same  result  in  the  various  State  organizations. 
As  in  the  national  association,  so  in  the  State  societies  the 
thoughts  of  the  members  are  cribbed,  cabined  and  confined. 
If  any  one  so  far  forgets  himself  as  to  dissent  from  the 
established  order  he  is  made  to  feel  the  sting  of  disapproval, 
until  he  is  glad  to  hide  himself  and  his  views  from  the  gaze 
of  his  associates.  With  few  exceptions  the  official  organs  in 
decency  and  order  embalm  the  intellectual  efforts  presented 
at  the  annual  gathering,  and  these  few  exceptions  are  the 
organs  conducted  by  editors  really  having  some  ideas  of  their 
own,  and  these,  strange  to  say,  progressive  ones.  Delegates 
to  the  annual  sessions  vote  their  aye,  aye,  with  a  feeling  that 
they  have  done  their  duty,  regretting  meanwhile  the  necessity 
for  absenting  themselves  from  the  scientific  sessions,  which 
in  their  turn  are  attended  by  others  who  vote  aye,  aye,  and 
who  in  turn  wish  they  were  delegates  and  could  really  do 
something.     The  machine  is  well-oiled  and  the  steam  roller 


26 

runs  smoothly.  Members  are  extremely  careful  to  avoid  be- 
ing run  over.     Hence,  whatever  is,  is  right." 

Dr.  W.  C.  Gorgas.  while  President  of  the  American  Med- 
ical Association  in  1910,  said^: 

"Our  association  is  probably  the  most  compactly  organized 
body  of  men  in  the  whole  country.  Its  branches  are  located 
in  ever)'-  part  of  the  country.  Through  the  county  and  state 
society  we  can  reach  all  National  legislators.  This  gives  us 
great  influence  on  legislation.  During  the  past  year  our  Com- 
mittee on  Aledical  Legislation  has  been  very  active  and  suc- 
cessful in  shaping  National  legislation." 

Efforts  to  Secure  Assistance  of  Philanthropic  Organiza- 
tions.— The  following  resolution  in  regard  to  women's  clubs 
was  passed  by  the  Council  on  Health  and  Public  Instruction 
of  the  American  Medical  Association,  June,  1911 : 

"Resolved,  That  this  committee  be  made  a  standing  com- 
mittee of  the  Council  on  Health  and  Public  Instruction  to  be 
known  as  the  Committee  for  Public  Health  Education  Among 
Women,  and  that  either  men  or  women  may  be  members 
thereof,  and  that  this  committee  shall  have  charge  of  the 
dissemination  of  information  concerning  the  nature  and  pre- 
vention of  diseases,  among  women's  clubs,  mothers'  and  teach- 
ers' organizations,  church  and  settlement  groups,  Young 
Women's  Christian  Association,  etc." 

Committees  have  been  appointed  from  time  to  time  by  the 
American  Medical  Association  to  confer  with  committees  ap- 
pointed by  the  National  Education  Association. 

At  the  meeting  of  the  Council  on  Health  and  Public  In- 
struction of  the  American  Medical  Association,  October  19, 
1913,  a  proposition  was  considered  of  calling  "a  conference 
of  executive  officers  of  the  leading  organizations  to  discuss 
mutual  co-operation  and  proper  division  of  the  field,  with  the 
elimination  of  unnecessary  organizations  and  the  co-ordination 
of  existing  activities."    The  Council  authorized  the  Secretary 


^Address  by  Dr.  Gorgas  at  St.  Louis,  June  6,  1910,  published  in  the  Journal  of 
the  American  Medical  Association,  June  11,   1910,  p.   1963. 


to  issue  an  invitation  for  a  conference  in  New  York.  This 
was  held  at  the  headquarters  of  the  American  Association  for 
Labor  Legislation  on  April  12,  1912. 

Should  the  Motive  Be  Questioned? — Can  it  be  seriously 
contended  that  the  American  Aledical  Association  has  the  pub- 
lic welfare  solely  or  mainly  in  view  in  thej  desperate  effort 
it  is  making  to  secure  the  co-ordination  of  the  many  national 
organizations  which  are  being  conducted  for  the  public  wel- 
fare? Whatever  the  motive  of  the  American  Medical  Asso- 
ciation may  be  its  action  is  in  line  with  the  following  recom- 
mendation by  Dr.  W.  A.  Evans,  formerly  Commissioner  of 
Health  of  Chicago^ : 

"As  I  see  it,  the  wise  thing  for  the  medical  profession  to 
do  is  to  get  right  into  and  man  every  great  health  movement; 
man  health  departments,  tuberculosis  societies,  child  and  in- 
fant welfare  societies,  housing  societies,  etc. 

"The  future  of  the  profession  depends  on  keeping  matters 
so  that  when  the  public  mind  thinks  of  these  things,  it  auto- 
matically thinks  of  physicians,  and  not  of  sociologists  or  sani- 
tary engineers.  The  profession  cannot  afford  to  have  these 
places  occupied  by  others  than  medical  men." 

Opposition  Within  Allopathic  Medical  Profession. — The 
allopathic  or  so-called  "regular"  physicians  are  by  no  means 
unanimous  in  favor  of  the  establishment  of  a  national  de- 
partment of  health  and  other  paternalistic  medical  legislation 
tending  to  centralize  health  matters  with  the  Federal  Govern- 
ment. 

The  late  Dr.  H.  B.  Favill  and  other  prominent  leaders  in 
the  American  Medical  Association  have  on  a  number  of  oc- 
casions voiced  their  disapproval  of  attempts  by  that  associa- 
tion to  influence  legislation. 

The  very  pronounced  opposition  among  allopathic  physi- 
cians against  the  establishment  of  a  national  department  of 


^Address  by  Dr.  W.  A.  Evans,  formerly  Commissioner  of  Health,  Chicago, 
Illinois,  before  the  Section  on  Preventive  Medicine  and  Public  Health  of  the 
American  Medical  Association,  Los  Angeles,  June,  1911,  as  reported  in  the  Journal 
of  the  American   Medical  Association,   September   16,   1911. 


S8 

health,  Federal  appropriations  for  maternity  and  infancy  care, 
for  so-called  "physical  education",  etc.,  is  indicated  very  em- 
phatically by  an  editorial  appearing  in  the  Illinois  Medical 
Journal,  the  official  organ  of  the  Illinois  State  Medical  So- 
ciety, for  May,  1920. 

The  editorial  is  entitled,  "Paternalism  Running  Wild — Two 
Hundred  and  Fifty  Million  Dollars  for  Socializing  Propa- 
ganda." It  calls  special  attention  to  S.  233,  for  maternity 
and  infancy  care;  S.  1017  for  the  creation  of  a  department 
of  education  and  containing  certain  medical  provisions;  S. 
2507  for  a  department  of  health,  and  a  number  of  other  bills 
and  says: 

"The  appropriations  provided  for  by  these  bills  aggregate 
$233,740,000. 

"Adding  to  this  sum  the  many  millions  otherwise  appropri- 
ated for  the  U.  S.  Pubhc  Health  Service,  the  Children's  Bu- 
reau, the  Vital  Statistics  Division  of  the  Census  Office,  the 
Interdepartmental  Board  of  Social  Hygiene,  would  probably 
bring  appropriations  for  this  work  up  to  four  hundred  mil- 
lions or  perhaps  a  half  a  billion  dollars.  This  is  going  some, 
to  say  the  least. 

"Where  will  it  all  end  ?  We  know  where  it  ended  in  ruined 
Russia.  Are  we  a  people  so  favored  that  we  can  sow  the 
wind  and  fail  to  reap  the  whirlwind,  that  we  can  play  with 
pitch  and  elude  defilement,  set  in  motion  efficient  cases  and 
escape  effects,  establish  a  system  of  autocracy  embracing  every 
human  activity,  and  continue  to  be  a  Nation  of  free  people, 
a  Republic  and  indestructible  union  of  indestructible  States? 

*     *     *    * 

"Unless  the  drift  toward  Bureaucratic  Government  is 
stopped,  Americans  will  be  the  most  ruled  and  standardized 
people  in  the  world,  and  we  will  need  armies  of  citizens  to 
enforce  all  the  laws;  by  and  by  we  shall  all  be  government 
employes,  earning  our  pay  by  watching  one  another.  Then, 
surely,  the  millennium  will  have  been  reached." 


CHAPTER  III. 

PREVENTIVE  MEDICINE  PROGRAM  NOT  CONDU- 
CIVE TO  PUBLIC  HEALTH 

"The  trend  and  spirit  of  medical  schools  is  toward  curative  medi- 
cine. The  graduates  of  our  best  medical  schools  today  are  not 
fitted  to  do  public  health  work.     . 

"It  is  a  matter  for  consideration  whether  the  medical  profession 
should  fit  men  for  preventive  medicine  or  turn  the  job  over  to 
somebody  else.  The  sanitary  engineer  as  an  all  around  man  is 
better  _  fitted  as  an  epidemiologist  than  the  average  physician." — 
Dr.  Victor  C.  Vaughan,  ex-president,  American  Medical  Associa- 
tion.^ 

4  4  PREVENTIVE  MEDICINE"  is  defined  in  Gould's  Med- 
A  ical  Dictionary  as  "the  department  of  medicine  dealing 
with  the  means  and  methods  of  preventing  disease."  The 
term  is  sometimes  used  to  include  sanitary  engineering,  food 
inspection  and  anything  else  dealing  with  the  problem  of  public 
health.  When  so  used,  however,  it  is  a  misnomer  because 
sanitary  engineering  and  food  inspection  do  not  properly  be- 
long under  the  heading  of  a  "department  of  medicine".  Pre- 
ventive Medicine,  on  the  other  hand,  embraces  measures  for 
medical  teaching,  examination  or  treatment  of  the  public  for 
the  alleged  purpose  of  protecting  the  public  health. 

Public  Being  Taught  To  Think  of  Disease  Instead  of 
Health. — One  result  of  the  "Preventive  Medicine"  campaign 
is  to  teach  the  people  to  think  of  sickness,  disease,  and  death 
instead  of  health  and  life.  So-called  "Public  Health"  lectures 
are  being  given  all  over  the  country  describing  the  symptoms 
and  causes  of  tuberculosis  and  other  diseases  to  children  and 
adults.  Germs  or  microbes  and  the  ravages  of  disease  are 
pictured  by  word  of  mouth,  by  pictures,  charts  and  moving 


*As  reported  in  the  Journal  of  the  American  Medical  Association,  April  3,  1920, 
p.  975. 


30 

picture  films.  These  lectures  are  not  only  being  given  to 
adults  but  are  frequently  delivered  before  children  in  the 
public  schools. 

In  a  discussion  of  "Methods  for  Extending  Popular  Educa- 
tion in  Public  Health  and  Preventive  Medicine,"^  Dr.  Mazyck 
P.  Ravenel,  Madison,  Wisconsin,  tells  about  using  the  theater 
as  a  means  of  popularizing  the  germ  theory  of  disease.  He 
says : 

"In  regard  to  the  use  of  the  theater  for  instructing  the 
public  along  the  lines  of  preventive  medicine,  may  I  tell  you 
what  we  have  done  at  Wisconsin?  ]\Iany  of  you  have  prob- 
ably seen  notices  in  the  newspapers  of  the  play,  'In  Germ- 
land'.  This  was  given  by  the  young  ladies  taking  work  in 
the  department  of  bacteriology  and  hygiene  at  the  University 
of  Wisconsin.  The  characters  were  all  dressed  in  costumes 
representing  as  nearly  as  possible  various  germs  as  we  see 
them  in  stained  preparations,  both  the  useful  and  the  harmful 
germs  being  represented.  No  charge  was  made  for  admission, 
cards  of  invitation  being  issued.  It  was  given  as  a  depart- 
ment matter  for  our  own  entertainment  and  instruction,  yet 
the  demand  for  admission  from  outside  taxed  the  resources 
of  our  hall  to  the  utmost,  and  throughout  the  country  the 
greatest  interest  was  excited. 

"Our  stage  scenery  was  made  as  instructive  as  possible. 
We  showed  dirty  roller  towels  on  the  wall,  spittoons,  garbage 
cans  marked  No.  23,  the  common  drinking  cup,  the  common 
sponge,  the  feather  duster,  the  broom — emphasizing  as  much 
as  possible  the  bad  features  of  such  things.  We  had  a  large 
rat-trap  containing  the  rats  which  the  women  have  been  wear- 
ing in  their  hair  so  much  of  late.  A  garbage  barrel  filled  with 
broken  bottles  and  tin  cans  was  called  the  'Germ-ania 
Theater'  and  the  play  announced  was,  The  Place,  the  Man, 
and  the  Germ.' 

"These  things  as  we  presented  them  were  quite  amusing. 


^Transactions   of  the  Section  of  Preventive   Medicine  and  Public   Health   o*  the 
American  Medical  Association,  held  at  St.   Louis,   Mo.,  June  7-10,   1910,  pp.  47-48. 


31 

They  catch  the  popular  eye  and  at  the  same  time  give  a  great 
amount  of  instruction  to  those  who  have  never  thought  on 
such  matters  before.  This  play  is  being  revised  and  improved 
and  during  the  coming  year  is  to  be  put  on  the  stage  by  pro- 
fessionals. I  am  sure  this  sort  of  work  will  do  an  enormous 
amount  of  good  in  educating  the  public." 

An  illustration  of  what  the  average  allopathic  physician 
means  by  the  teaching  of  sanitation  is  given  by  a  text  book 
which  has  been  used  in  a  number  of  public  schools  entitled 
"Primer  of  Sanitation:  Being  a  Simple  Work  on  Disease 
Germs  and  How  to  Fight  Them."  The  following  is  a  list  of 
the  chapters  it  contains :  "Why  the  study  of  disease  germs  is 
important ;  The  cells  of  the  body ;  Disease  germs  and  how  they 
get  into  the  body ;  The  struggle  between  the  body  and  the 
germs ;  Bacteria ;  The  skin ;  The  pus-forming  bacteria ; 
Tetanus  (lockjaw);  The  air  passages  and  the  lungs;  Diph- 
theria; Pneumonia;  Influenza;  Whooping  cough,  and  colds; 
Tuberculosis ;  The  treatment  of  consumption ;  Disease  germs 
in  dust ;  The  alimentary  canal ;  Typhoid  fever ;  Diseases  caused 
by  relatives  of  the  typhoid  germ;  Other  bacterial  diseases  of 
the  intestines ;  Disease  germs  in  water ;  Other  bacterial  dis- 
eases; Protozoa;  Malarial  fever  and  yellow  fever;  Mosqui- 
toes ;  Smallpox ;  Other  protozoan  diseases ;  Intestinal  worms ; 
The  importance  of  sanitation;  The  housefly;  Disease  germs  in 
food ;  Disinfection ;  Unhygienic  habits ;  Public  sanitation ; 
V\^hat  governments  can  do  to  preserve  the  public  health ;  Prac- 
tical sanitation." 

An  Age  of  Vaccines  and  Serums. — Some  idea  of  the  vast 
accumulating  traffic  in  vaccines  and  serums  may  be  gained 
from  the  fact  that  at  the  end  of  the  fiscal  year  June  30,  1919. 
thirty-one  establishments  were  holding  licenses,  issued  by  the 
Treasury  Department  of  the  Federal  Government,  in  accord- 
ance with  the  act  of  Congress  approved  July  1,  1903,  regu- 
lating the  sale  of  viruses,  serums,  etc.,  and  eighty-nine  differ- 
ent products  were  licensed. 

The  wholesale  system  of  compulsion  contemplated  under 


32 

so-called  ''Preventive  Medicine"  may  be  inferred  from  the 
following  extracts  from  an  article^  by  Dr.  Joseph  A.  White 
in  the  Charlotte  Medical  Journal : 

"Vaccination  against  typhoid  fever  is  being  experimented 
with  and  has  been  partially  successful. 

"The  scientific  application  of  this  principle  to  bacterial  dis- 
eases, it  is  hoped,  will  ultimately  give  us  such  results  that  most 
of  these  diseases  will  be  a  thing  of  the  past.    *    *    *    * 

"It  is  hoped  that  some  day  a  specific  will  be  found  for 
every  germ  disease,  that  is  a  remedy  that,  when  taken  into 
the  system,  will  destroy  the  disease  germ  without  injuring  the 
healthy  tissues. 

"Protective  inoculation,  as  in  smallpox,  (Jenner)  is  to  pro- 
duce, artificially,  a  state  of  immunity  against  certain  poisons 
that  produce  disease,  by  being  inoculated  with  the  bacteria, 
or  bacterial  products,  of  that  disease;  just  as  an  attack  of 
smallpox,  the  scarlet  fever,  yellow  fever,  etc.,  protects  against 
a  subsequent  attack.     *    *     *    * 

"When  scientific  medicine  has  discovered  the  cause  of  any 
diseases,  and  demonstrated  that  it  can  be  controlled  or  pre- 
vented by  certain  measures  provided  these  measures  can  be 
applied,  it  is  the  duty  of  the  state  to  vest  its  health  authori- 
ties with  the  power  to  enforce  their  application  whenever  and 
wherever  needed. 

"As  for  example,  compulsory  vaccination  for  smallpox,  the 
compulsory  use  of  antitoxin  in  diphtheria,  etc.,  just  as  we  now 
have  compulsory  quarantine  in  well  known  infectious  and 
contagious  diseases  by  excluding  or  isolating  persons  who 
have  been  exposed  to  the  risk  of  contagion.  The  question  of 
invasion  of  personal  rights  and  personal  liberty  should  never 
obtain  in  the  case  of  the  few  when  we  consider  the  risk  of  the 
many." 

The  "Carrier"  Theory. — The  examination,  isolation  and 


^"Preventive  Medicine.  What  it  has  done,  and  What  It  can  do,  If  the  State 
will  but  Recognize  Its  Obligations  to  the  Public,"  by  Joseph  A.  White,  A.  M., 
M.  D.,  Richmond,  Va.,  in  The  Charlotte  (N.  C.)  Medical  Journal,  June,  1911, 
p.  375. 


33 

medical  treatment  of  healthy  persons  under  the  theory  that 
they  are  "carriers"  or  are  suspected  of  being  "carriers"  of 
disease  also  plays  a  leading  roll  under  what  is  called  preventive 
medicine. 

Efforts  to  secure  the  enactment  of  legislation  providing  for 
the  examination,  isolation  and  medical  treatment  of  healthy 
persons  under  the  theory  that  they  are  "carriers"  or  are  sus- 
pected of  being  carriers  offers  a  striking  illustration  of  the 
unwarranted  interference  with  healthy  persons  that  results 
from  allowing  one  profession  and  one  branch  of  that  profes- 
sion such  complete  control  over  our  public  health  activities. 

That  the  carrier  theory  is  only  a  "theory"  is  intimated  in  the 
following  statement  by  Dr.  Shaw^: 

"With  the  advance  of  scientific  research  our  old  pet  theories 
go  on  the  scrap  heap  while  new  theories  are  evolved.  Now 
that  transmission  of  disease  through  the  air  and  by  fomites 
has  been  disproved,  the  present  explanation  is  that  communi- 
cable disease  is  transmitted  only  by  means  of  infected  persons, 
unrecognized  cases  and  healthy  carriers." 

The  word  "fomites"  in  the  above  refers  to  clothing,  bedding, 
etc.,  which,  according  to  past  theory,  were  supposed  to  trans- 
mit germ  infection. 

Charles  E.  Simon,  M.  D.,  in  a  recent  book  entitled  "Human 
Infection  Carriers"^  mentions  the  following  diseases  as  being 
spread  by  "carriers" ;  cholera,  diphtheria,  typhoid  fever,  enteric 
fever,  meningococcus  meningitis,  poliomyelitis  and  certain 
forms  of  streptococcus  infection,  as  well  as  certain  types  of 
pneumococcus  pneumonia.  He  also  states  that  "future  in- 
vestigations will  no  doubt  show  that  still  other  infectious  dis- 
eases are  transmitted  through  the  activity  of  carriers  of  the 
type  that  we  are  here  considering." 

According  to  Ralph  A.  Kinsella,  M.  D.,  Major,  M.  C,  U.  S. 


i"The  Cause  of  a  'Sporadic'  Case  of  Cerebro-Spinal  Meningitis,"  by  Henry  L.  K. 
Shaw,  M.  D.,  in  the  American  Journal  of  Diseases  of  Children,  August,  1919, 
p.  104. 

*Simon,  C,  E.;  Human  Infection  Carriers,  Philadelphia,  Lea  &  Febiger,  1919, 
p,    18-19. 


34 

Army,  the  Pfeiffer  bacillus  (the  most  generally  favored  can- 
didate for  the  position  of  the  bacillus  of  influenza)  has  been 
recovered  in  normal  throats,  in  times  when  no  epidemic  of  in- 
fluenza existed.     He  says^ : 

"The  report  of  the  pneumonia  commission  at  Camp  Pike, 
written  long  before  influenza  appeared  in  this  country,  is  of 
value.  Sputums  from  132  normal  individuals  were  studied  by 
injecting  the  sputums  into  white  mice,  Pfeiflfer  bacilli  were 
recovered  in  about  35  per  cent  of  the  cases." 

According  to  the  New  York  City  Department  of  Health's 
Weekly  Bulletin  for  March  15,  1919,  it  is  estimated  that  about 
one  per  cent  of  the  people  of  the  city  carry  virulent  diph- 
theria bacilli  in  their  throats.     It  says : 

"In  connection  with  the  question  of  dealing  with  all  sources 
of  diphtheria  bacilli,  D'r.  Park  estimates  that  about  one  per 
cent  of  the  people  of  the  city  harbor  virulent  bacilli  in  their 
throats,  and  that  it  is  not  feasible  to  utilize  throat  cultures  on 
a  sufficiently  large  scale  to  discover  all  carriers  in  the  com- 
munity or  to  affect  the  general  incidence  of  the  disease.  As- 
suming that  we  could  discover  the  50,000  or  more  persons 
who  are  carriers  of  virulent  diphtheria  bacilli  under  this  esti- 
mate, it  is  obvious  that  it  would  be  impracticable  to  isolate  so 
many." 

Dr.  Charles  E.  Simon  in  "Human  Infection  Carriers",  pre- 
viously referred  to,  estimates  the  number  of  typhoid  carriers 
in  New  York  City  as  25,000  or  0.3  to  0.4  per  cent  of  the  total 
population  of  any  large  city. 

In  other  words,  if  we  are  to  be  consistent  and  carry  out 
the  "carrier"  theory  logically,  and  if  it  is  found  that  thirty- 
five  per  cent  of  the  people  are  carriers  of  the  Pfeiffer  or  in- 
fluenza bacillus,  it  would  mean  the  isolation  of  over  thirty-five 
million  people  as  a  protection  against  influenza. 

If  one  per  cent  of  the  people  are  carriers  of  diphtheria,  it 
would  mean  the  isolation  of  over  one  million  healthy  persons 
SLS  carriers  of  that  disease. 

'In    an   article    by    Dr.    Kinsella,    published    in   the    Journal    of    the    American 
Medical  Association,  March  8,   1919,  p.  720, 


If  0.3  to  0.4  per  cent  of  the  population  are  carriers  of  ty- 
phoid fever,  it  would  mean  the  isolation  of  300,000  to  400,000 
persons  as  carriers  of  that  disease. 

Furthermore,  according  to  Charles  E.  Simon  in  "Human 
Infection  Carriers"  previously  referred  to,  it  is  estimated  that 
there  are  an  average  of  ten  carriers  to  one  meningitis  patient 
"and  as  carriers  beget  carriers  it  is  manifestly  impossible  to 
discover  them  all." 

Dr.  David  J.  Davis  in  an  article  published  in  the  Illinois 
Medical  Journal  for  September,  1919,  goes  still  further  and 
estimates  that  "practically  everyone"  is  a  carrier  of  "typical 
hemolytic  streptococci". 

In  short  the  proposal  to  arrest  and  isolate  so-called  "car- 
riers" of  disease  leads  to  a  "reductio  ad  absurdum". 

To  appreciate  the  fallacy  of  the  carrier  theory  as  applied 
to  any  particular  disease  it  is  only  necessary  to  perform  a 
few  arithmetic  calculations.  If  the  one  million  healthy  per- 
sons who  are  classified  as  harboring  virulent  diphtheria  germs 
are  an  actual  menace  to  others  and  if  each  one  of  them  in- 
fected only  one  person  a  week  it  would  require  less  than  six 
weeks  to  infect  the  other  ninety-nine  millions.  Similar  cal- 
culations may  be  made  for  typhoid  fever  and  other  diseases. 

As  an  example  of  the  extreme  measures  already  resorted 
to  in  conformity  with  the  program  for  isolating  "carriers" 
attention  is  called  to  the  surgical  treatment  of  six  alleged 
"Typhoid  Carriers"  in  the  Army  as  described  in  an  article 
by  Drs.  Nichols,  Simmons  and  Stimmel,  published  in  the  Jour- 
nal of  the  American  Medical  Association,  August  30,  1919, 
p.  680.     It  says: 

"Some  of  these  men  consented  willingly  to  operation  when 
the  condition  was  explained.  Others  at  first  refused;  but 
when  it  was  made  clear  to  them  that  during  the  war  they 
were  subject  to  court  martial  if  they  refused  an  operation 
that  might  fit  them  for  duty,  they  also  agreed  to  operation." 

According  to  the  article  above  referred  to  one  of  the  men 
had  what  was  called  a  nephrectomy,  i.  e.  the  "surgical  excision 


36 

of  the  kidney"  and  five  of  the  men  had  what  were  called 
"cholecystectomy"  operations,  i.  e.  "the  operation  of  cutting 
out  the  gall-bladder." 

According  to  Dr.  Louis  I.  Harris  in  the  Monthly  Bulletin 
of  the  Department  of  Health,  City  of  New  York,  for  August, 
1919,  three  (alleged)  typhoid  carriers  "are  detained  forcibly 
in  the  Health  Department  hospitals"  and  67  others  are  per- 
mitted to  stay  at  home,  but  kept  under  constant  supervision. 

Says  Program  Increases  Physician's  Practice. — It  is  per- 
fectly obvious  that  the  effect  of  all  these  measures  coming 
under  the  classification  of  "Preventive  Medicine"  is  to  enor- 
mously broaden  the  field  of  medical  practice.  Referring  to 
"The  Relationship  of  the  State  Department  of  Public  Health 
and  the  Medical  Profession",  Dr.  C.  St.  Qair  Drake,  Director 
of  the  State  Department  of  Health,  Springfield,  Illinois,  in  an 
article  in  the  Illinois  Medical  Journal  for  August,  1919,  lays 
special  emphasis  upon  the  "increased  practical  returns  to  the 
physician"  as  a  result  of  periodical  physical  examination  of 
everybody  and  other  measures  which  the  Illinois  State  De- 
partment of  Health  is  urging  at  this  time.     He  says : 

"Modern  health  administration  in  asking  much  of  the  phy- 
sician is  likewise  giving  much  to  the  physician.  The  indi- 
vidualization of  health  work,  instead  of  threatening  the  mate- 
rial interests  of  the  doctor,  actually  benefits  him  in  many  ways. 
It  is  safe  to  say  that  the  more  intimately  the  individual  phy- 
sician becomes  acquainted  with  the  aims  and  purposes,  the 
activities  and  underlying  motives  of  the  State  Department  of 
Health,  the  more  valuable  his  influence  becomes  to  the  people 
of  his  community  and  the  more  useful  the  department  becomes 
to  him  in  the  pursuit  of  his  practice. 

"Health  officials  are  urging  at  this  time  periodical  physical 
examination  for  all  persons  as  the  means  of  detecting  in- 
sidious, organic  diseases  in  their  incipient  and  easily  curable 
stages  and,  while  the  medical  profession  may  be  called  upon 
at  certain  times  to  render  gratuitous  service  in  such  examina- 
tions for  purposes  of  education  and  demonstration,  it  is  un- 


37 

questionably  true  that  the  establishment  of  this  excellent  cus- 
tom is  not  only  capable  of  saving  or  prolonging  thousands  of 
human  lives,  but  brings  increased  practical  returns  to  the 
physician." 

Tendency  Is  to  Belittle  Value  of  Real  Sanitation. — The 

preventive  medicine  program  affects  the  public  health  detri- 
mentally in  two  ways:  First,  by  encouraging  the  injection  of 
foreign  matter  into  the  pure  blood  of  well  people,  thereby  off- 
setting or  tending  to  offset  the  benefits  derived  by  sanitation; 
and,  second,  by  turning  the  attention  of  the  public  and  public 
health  agencies  away  from  sanitation  (or  the  control  of  the 
physical  conditions  which  are  largely  responsible  for  disease) 
and  centering  it  on  the  control  of  the  bodies  of  the  people. 

That  sanitary  engineering,  including  the  furnishing  of  a 
pure  water  supply  and  the  proper  disposal  of  sewage  is  being 
crowded  out,  according  to  the  present-day  theorists  on  pre- 
ventive medicine  is  indicated  by  the  following  declaration  of 
Dr.  Henry  L.  K.  Shaw^ : 

"It  is  difficult  to  make  the  public  and  even  members  of  the 
medical  profession  realize  that  persons,  not  things,  are  re- 
sponsible for  the  transmission  of  communicable  disease. 
Many  instances  of  alleged  fomites  infection  were  doubtless 
cases  of  carrier  infection.  Persons  in  whom  the  germs  are 
growing  are  much  more  likely  to  be  the  agents  of  infection 
than  are  objects  on  which  the  germs  are  dying. 

"Hill  sums  up  the  present  views  as  follows :  The  old  pub- 
lic health  was  concerned  with  the  environment,  the  new  is 
concerned  with  the  individual.  The  old  sought  the  sources  of 
infectious  diseases  in  the  surroundings  of  man;  the  new  finds 
them  in  man  himself.  The  old  public  health  sought  these 
sources  in  the  air,  in  the  water,  in  the  climate  and  topography 
of  localities,  in  the  temperature  of  soils  at  the  depth  of  four 
and  six  feet,  in  the  rise  and  fall  of  ground  water,  and  failed 
because  it  sought  them,  very  painstakingly  and  exhaustively, 

*"The  Cause  of  a  'Sporadic'  Case  of  Cerebro-Spinal  Meningitis,"  by  Henry 
L.  K.  Shaw,  M.  D.,  in  the  American  Journal  of  Diseases  of  Children,  August, 
1919,  p.   103. 


38 

it  is  true,  in  every  place  and  everything  where  they  were  not. 
The  new  pubHc  health  seeks  these  sources — and  finds  them — 
among  those  infected  persons  (or  animals)  whose  excreta  or 
other  constituents  or  body  contents  enter  the  bodies  of  other 
persons." 

In  an  article  appearing  in  the  Journal  of  the  American  Med- 
ical Association,  Dr.  Furstman,  Commissioner  of  Health,  La 
Crosse,  Wisconsin,  also  belittles  the  value  of  sanitation.  He 
says^ : 

"In  the  past  we  have  paid  altogether  too  much  attention  to 
the  environment  and  too  little  to  the  individual  in  the  spread 
of  contagious  diseases.     *     *     *     * 

"I  am  very  sorry  to  say  that  sanitation  as  a  phase  of  health 
work  has  been  the  most  popular  and  one  that  is  probably 
bringing  us  the  least  results  for  the  money  spent.  With  the 
old  ideas  as  to  the  spread  of  contagious  diseases  we  can  readily 
see  why  this  has  been  so  popular.  But  since  most  of  us  know 
better,  why  don't  we  change  our  methods  ?  Most  of  us  know 
that  we  are  not  saving  any  lives  through  the  removal  of  gar- 
bage and  that  this  activity  should  be  taken  out  of  health  work, 
but  we  still  continue  to  attend  to  it  because  the  public  demands 
that  we  take  care  of  it.  A  great  deal  of  money  is  being  spent 
on  food  inspection,  while  little  or  nothing  is  being  done  to  see 
whether  the  people  that  are  handling  the  food  are  suffering 
from  tuberculosis,  venereal  disease  or  other  contagious  dis- 
eases. 

"I  do  not  want  to  infer  that  there  is  no  good  accomplished 
from  proper  sanitation,  but  T  do  think  we  have  been  giving 
altogether  too  much  credit  to  this  work." 

Dr.  W.  A.  Evans,  formerly  health  commissioner  of  Chicago, 
takes  the  position  that  vaccination  is  "far  cheaper  than  boiling 
the  water  or  treating  it  with  chemicals."     He  says^: 

^Article  by  J.  M.  Furstman,  M.  D.,  Commissioner  of  Health,  La  Crosse,  Wis- 
consin, in  the  Journal  of  the  American  Medical  Association,  November  2,  1918, 
p.    1463. 

'Article  by  Dr.  W.  A.  Evans,  in  the  Chicago  Tribune,  August  24,  1918,  and 
syndicated  in   other  papers. 


39 

"We  have  now  vaccinated  nearly  three  million  soldiers  and 
sailors  since  the  war  began.  *  *  *  These  men  have  had 
no  typhoid,  and  will  have  none.  *  *  *  j  have  seen  many 
surgeons  vaccinating  against  typhoid  at  the  rate  of  400  an 
hour.  *  *  *  The  method  is  far  cheaper  than  boiling  the 
water  or  treating  it  with  chemicals." 

Failure  to  observe  proper  sanitary  precautions  in  many 
units  of  the  American  Expeditionary  Forces  "due  to  a  false 
sense  of  security  under  the  popular  belief  that  vaccination 
against  typhoid  and  paratyphoid  gives  a  complete  immunity 
even  in  the  midst  of  gross  insanitary  conditions"  resulted  in 
the  occurrence  and  distribution  of  typhoid-paratyphoid  in 
many  units,  according  to  Walter  D.  McCaw,  Colonel,  Medical 
Corps,  Chief  Surgeon.    He  says^: 

"The  occurrence  and  distribution  of  typhoid-paratyphoid 
in  our  troops  has  constantly  and  continuously  been  brought  to 
the  attention  of  all  medical  officers  serving  with  the  American 
Expeditionary  Forces,  through  the  medium  of  the  weekly 
bulletin  of  diseases.  It  would  appear,  however,  that  many 
officers  have  utterly  failed  to  grasp  the  significance  of  these 
reports  and  warnings,  a  fact  which  may  be  due  to  a  false 
sense  of  security  under  the  popular  belief  that  vaccination 
against  typhoid  and  paratyphoid  gives  a  complete  immunity 
even  in  the  midst  of  gross  insanitary  conditions." 

^Article  in  "Public  Health  Reports,"  published  by  the  U.  S.  Public  Health  Serv- 
ice.  March  28,  1919,  p.  605. 


CHAPTER  IV. 

PRACTICE  OF  HEALING  ART  A  PRIVATE 
FUNCTION 

"The  relation  of  the  Church,  or  of  all  the  Churches,  to  the  State 
is  one  of  the  problems  which  the  Republic  may  be  said  to  have 
solved.     It  is  decided  that  it  has  no  relation  whatever. 

"The  State  has  as  much  relation  to  religion  as  to  medicine,  and 
no  more ;  and  it  might  as  well  establish  Homeopathy  as  its  medi- 
cal system,  as  Episcopacy  as  its  religion," — The  Late  Andrew  Car- 
negie in  "Triumphant  Democracy." 

THE  history  of  medicine  should  serve  as  a  warning  against 
the  Government  employing  physicians  or  nurses  to  fur- 
nish medical  treatment  or  medical  advice  to  the  public  gen- 
erally. 

From  early  times  the  "regular"  or  allopathic  medical  prac- 
tice has  centered  around  seven  or  eight  well-defined  pro- 
cedures; viz.,  bleeding  and  blistering;  the  administration  of 
emetics  and  purgatives ;  stimulants  and  sedatives ;  vaccines  and 
serums,  and  surgery.  ■  Bleeding  and  blistering  have  been 
abandoned  while  the  use  of  vaccines  and  sertims  is  compara- 
tively recent. 

At  the  present  time  there  are  numerous  systems  or  schools 
of  healing  which  do  not  employ  any  of  the  procedures  men- 
tioned above ;  others  which  employ  one  or  two  of  the  methods 
mentioned  above  but  not  to  the  same  extent  or  in  the  same  way 
as  the  graduates  of  allopathic  colleges.  The  number  of  ad- 
herents of  non-allopathic  systems  of  healing  has  been  esti- 
mated to  be  thirty-five  million  persons  in  the  United  States. 
Adding  to  this  estimate  those  who  patronize  graduates  of  allo- 
pathic colleges  who  specialize  in  surgery,  bacteriology,  neu- 
rology, etc.,  the  percentage  of  adherents  of  non-allopathic 
systems  of  healing  or  so-called  specialists  would  be  well  over 
fifty  per  cent  of  the  population  in  the  United  States. 


41 

Practice  of  Medicine  in  Washington's  Time. — The  med- 
ical treatment  popular  in  George  Washington's  time  offers 
a  striking  illustration  of  the  extremes  to  which  the  dominant 
school  of  medicine  may  go  in  the  employment  of  dangerous 
practices. 

The  following  account  of  the  medical  treatment  which 
Washington  received  is  from  an  article  in  the  Monthly  Maga- 
zine and  American  Review,  published  in  1799,  which  was  re- 
printed in  the  New  York  Globe  and  Commercial  Advertiser 
for  February  23,  1920 : 

"The  necessity  of  blood-letting  suggesting  itself  to  the  Gen- 
eral he  procured  a  bleeder  in  the  neighborhood,  who  took 
from  his  arm  in  the  night  twelve  or  fourteen  ounces  of  blood. 
He  could  not  be  prevailed  on  by  the  family  to  send  for  the 
attending  physician  till  the  following  morning,  who  arrived  at 
Mount  Vernon  at  about  11  o'clock  on  Saturday.  Discover- 
ing the  case  to  be  highly  alarming,  and  foreseeing  the  fatal 
tendency  of  the  disease,  two  consulting  physicians  were  im- 
mediately sent  for,  who  arrived,  one  at  half  after  3,  and  the 
other  at  4  o'clock  in  the  afternoon. 

"In  the  meantime  were  employed  two  copious  bleedings,  a 
blister  was  applied  to  the  part  affected,  two  moderate  doses 
of  calomel  were  given,  and  an  injection  was  administered, 
which  operated  on  the  lower  intestines,  but  all  without  an\ 
perceptible  advantage,  the  respiration  becoming  still  more  dif- 
ficult and  painful. 

"On  the  arrival  of  the  first  of  the  consulting  physicians,  it 
was  agreed  as  there  were  yet  no  signs  of  accum.ulation  in  the 
bronchial  vessels  of  the  lungs,  to  try  the  effect  of  another 
bleeding,  when  about  thirty-two  ounces  of  blood  were  drawn 
without  the  least  apparent  alleviation  of  the  disease.  Vapors 
of  vinegar  and  water  were  frequently  inhaled,  ten  grains  of 
calomel  were  given,  succeeded  by  repeated  doses  of  emetic 
tartar,  amounting  in  all  to  five  or  six  grains,  with  no  other 
effect  than  a  copious  discharge  from  the  bowels. 

"The  power  of  life  seemed  now  manifestly  yielding  to  the 


43 

force  of  the  disorder ;  blisters  were  applied  to  the  extremities, 
tog'ether  with  a  cataplasm  of  bran  and  sugar  to  the  throat. 
Speaking,  which  had  been  painful  from  the  beginning,  now 
became  almost  impracticable ;  respiration  grew  more  and  more 
contracted  and  imperfect,  till  half  after  eleven  on  Saturday 
night,  when,  retaining  the  full  possession  of  his  intellects,  he 
expired  without  a  struggle. 

MEDICINE  NOT  A  SCIENCE 

Tendency  to  Fads. — In  a  lengthy  article  appearing  in  the 
Journal  of  the  American  Medical  Association  August  9,  1913, 
Dr.  Joseph  Zeisler,  Professor  of  Dermatology,  Northwestern 
University  Medical  School,  Chicago,  points  out  the  tendency 
of  allopathic  physicians  to  fads.     He  says: 

"There  was  a  time  when  ovaries  were  sacrificed  to  an  ex- 
tent amounting  to  a  fad.  The  same  criticism  might  perhaps 
without  much  injustice  be  made  today  as  to  appendectomy. 
A  few  in  this  audience  may  perhaps  recollect  that  short- 
lived fad  of  nerve  stretching  in  cases  of  tabes  or  may  still 
have  in  mind  the  time  when  galvanocautery  of  the  turbinated 
bodies  in  the  nose  was  practiced  for  the  relief  of  hay  fever, 
chronic  rhinitis,  and  almost  any  pathologic  state  in  the  nostrils 
with  a  great  deal  of  vigor  and  very  little  rationality.  The 
injections  of  paraffin  for  the  relief  of  cosmetic  defects  may 
also  be  classed  among  the  short-Hved  fads.  The  irreparable 
harm  which  this  practice  has  often  done  has  led  to  its  utter 
abandonment  except  in  rare  instances.  I  may  not  be  com- 
petent to  speak  about  matters  outside  of  our  own  special  do- 
main, but  my  impression  is  that  the  extent  to  which  Freud's 
psychanalysis  has  been  exploited  in  neurologic  literature  of 
late  borders  on  faddism.     *     *     *     * 

"In  former  times  I  could  make  the  almost  daily  observation 
that  physicians  in  general  and  even  specialists  were  very  slow 
in  adopting  any  form  of  treatment  which  required  the  regular 
use  of  a  hypodermic  syringe.     That  applied,  of  course,  par- 


43 

ticularly  to  the  treatment  of  syphilis.  All  this  has  changed 
wonderfully  of  late  when  almost  anything  is  being  treated  by 
the  injection  of  all  sorts  of  serums  and  the  so-called  vaccines 
or  bacterins.  I  feel  perfectly  incompetent  to  discuss  that  sub- 
ject in  general  from  its  many  points  of  view.  I  realize  its 
great  possibilities,  and  its  scientific  fundaments,  but  when  we 
see  that  vaccines  are  recommended  and  used  for  the  treatment 
of  vertigo,  hay-fever,  rheumatism  and  sciatica,  of  appendicitis 
and  gall-stones,  we  are  forced  to  regard  such  practices  as  fads. 
Regarding  purely  cutaneous  atfections,  their  use  in  sycosis  and 
fnrunculosis  is  today  pretty  well  established,  although  we  are 
far  from  possessing  sufficiently  exact  data  as  to  dosage  and 
frequency  of  injections.  I  can  only  look  with  mild  incredulity 
on  the  reports  of  the  cure  of  pruritus  ani  by  autogenous  vac- 
cines. I  should  require  better  proof  for  the  microbic  origin 
of  that  condition  before  I  can  accept  those  statements    *    *    * 

"Not  only  in  regard  to  therapeutics  do  we  find  a  tendency 
to  fads.  We  can  observe  a  similar  tendency  in  regard  to 
broad  pathologic  and  diagnostic  questions.  There  was  a 
period  in  dermatology  when  an  attempt  was  made  to  explain 
most  skin  diseases  of  unknow^n  etiolog}'  on  the  basis  of  tro- 
phoneurotic influences.  That  was  at  the  time  before  bacteriol- 
ogy had  become  established  in  its  varied  etiologic  relations. 
More  recently  the  subject  of  anaphylaxis  has  been  forced  into 
the  foreground  and  is  being  discussed  to  an  extent  and  used 
to  explain  the  cause  of  disease  in  a  manner  which  classes  it 
among  the  fads." 

Says  Not  Alv^rays  Able  to  Get  Bearings. — In  an  article 
recently  appearing  in  the  Journal  of  the  American  Medical 
Association  Dr.  Frederick  Peterson  of  New  York  points  out 
one  therapeutic  measure  after  another  which  has  been  heralded 
to  the  allopathic  medical  profession  and  later  rejected.  He 
says^ : 

"The  same  psychologic  factors  are  at  work  in  us  as  in  the 


^"Credulity   and   Cures,"    published   in   the   Journal    of  the   American    Medical 
Association,   December  6,    1919,   p.   1739. 


u 

general  public  for  the  creation  of  faith  in  the  new  drug  or  in 
the  new  method.  We  do  not  know  enough  about  it  to  be 
sufficiently  critical.  This  ignorance  of  ours  prepares  the 
ground  for  the  new  belief,  the  new  conviction.  Its  value  is 
asserted  by  authority.  And  we  are  eager  to  believe  in  the 
new  hope  of  help  held  out  to  us  for  the  healing  of  the  sick. 
Then,  again,  there  are  the  marvelous  mysteries  behind  all  the 
new  names — ^harmones,  opsonins,  endocrines,  amboceptors,  etc. 
— such  a  wide  field  for  new  facts,  such  a  vast  horizon  for  new 
theories.  We  can  hardly  be  blamed  for  not  being  always  able 
to  get  our  bearings  in  these  uncharted  seas. 

"It  has  interested  me  to  go  over  in  this  connection  some  of 
the  therapeutic  measures  heralded  to  the  profession  with  more 
or  less  vehemence  of  assertion  during  my  own  day.  Some  of 
these  have  already  passed  into  oblivion.  When  I  began  prac- 
tice, clitoridectomy  was  a  reputed  cure  for  many  nervous  dis- 
orders. One  scarcely  hears  of  it  now.  About  that  time,  too, 
surgeons  were  competing  for  their  first  hundreds  in  ovariot- 
omy, an  operation  often  then  performed  not  because  of  ovarian 
disease,  but  for  some  theoretical  relation  to  epilepsy,  insanity 
and  the  psychoneuroses.  Around  that  period  the  rhinologists 
came  into  their  own  with  the  turbinated  bone  obsession.  I 
suppose  the  reason  one  hears  so  little  of  it  now  is  that  most 
of  the  turbinated  bones  of  our  generation  were  removed.  Tur- 
binated bones  have  gone  out,  and  submerged  tonsils  have  come 
in.  In  Vienna  many  cases,  especially  those  of  nervous  dis- 
orders, were  cured  by  magnets  applied  to  the  spine.  Elec- 
tricity had  a  great  vogue,  and  large  static  and  other  machines 
v/ere  a  part  of  office  equipment.    One  rarely  sees  them  now. 

"For  a  time,  suspension  of  patients  with  locomotor  ataxia  on 
the  theory  that  stretching  the  spine  affected  favorably  the 
fibers  in  the  posterior  roots  had  vogue,  and  it  was  rather  start- 
ling to  enter  a  clinic,  hospital  or  doctor's  office  and  see  one 
man  or  several  men  hanging  by  the  head  from  a  miniature 
gallows.  The  passing  of  urethral  sounds  for  the  cure  of  loco- 
motor ataxia  had  a  brief  but  meteoric  career.     There  was  a 


45 

good  deal  of  trephining  for  microcepbalia,  under  the  impres- 
sion that  the  brain  would  grow  if  it  was  given  more  room; 
and  trephining  was  done  for  a  time  in  general  paresis  but 
abandoned  for  good  reasons  in  the  course  of  time.  The  rest 
cure  had  a  comparatively  long  life  among  remedial  measures, 
and  it  had  behind  it  great  authority  and  much  logic ;  but  as  a 
cure  it  owed  its  success  chiefly  to  the  psychotherapeutic  genius 
that  launched  it  into  existence.  Except  for  the  reverberations 
of  his  dicta  in  remote  places,  it  is  not  employed  nowadays, 
the  antipodes  of  his  teachings,  namely,  exercise  and  occupa- 
tional therapy,  taking  its  place.  I  suppose  very  few  drugs  have 
had  such  a  rapid  rise  and  sudden  drop  into  the  medical  limbo 
as  crotalin,  exploited  for  epilepsy.  It  ended  like  the  skyrocket. 
Perhaps  I  should  mention  here  in  connection  with  crotalin. 
Bacterium  cincinnaticum,  which  caused  so  many  epileptics  to 
have  their  colons  reduced  to  semicolons  by  operation.  This 
germ  is  extinct,  along  with  the  general  paresis  germ  discov- 
ered in  Scotland  some  years  ago. 

"I  presume  many  recall  a  series  of  volumes  entitled  'Bio- 
graphic Clinics,'  by  which  the  enthusiastic  author,  an  ophthal- 
mologist, sought  to  prove  that  the  majority  of  diseases  were 
due  to  eye  strain  and  could  be  corrected  by  prisms.  He  was 
very  bitter  against  certain  of  his  confreres  who  believed  in  the 
same  etiology  of  human  illnesses,  but  who  insisted  quite  vio- 
lently on  the  cutting  of  eye  m^uscles  by  a  long  series  of  delicate 
operations  to  remove  eye  strain.  The  originator  of  the  latter 
method  was  awarded  a  prize  by  a  distinguished  foreign  med- 
ical society  for  his  great  contribution  to  science! 

"Our  past  experience  should  lead  us  to  be  extremely  cau- 
tious and  skeptical  in  the  presence  of  many  of  the  therapeutic 
measures  before  us  now.  Leaders,  despite  their  great  intelli- 
gence, and  high  position,  often  stampede  the  rank  and  file  of 
us  like  sheep.  Our  leaders  are  very  human  and  subject  to 
the  sway  of  the  personal  equation.  T  know  one  general  con- 
sultant who  seldom  makes  a  diagnosis  of  anything  except 
hypothyroidism  or  hyperthyroidism ;  in  fact,  I  believe  that  he 


46 

must  in  his  mind  have  classified  the  whole  human  race  as 
superior  and  inferior  thyroids.  I  know  another  who  does  not 
see  ordinary  things  in  the  ordinary  light  of  day,  but  by  a 
prismatic  light;  he  sees  them  through  the  rainbow  of  the 
endocrines.  Surely,  so  much  pulling  of  teeth,  so  much  re- 
moval of  submerged  tonsils,  is  not  justified  by  results.  At 
least  I  feel  so  from  the  many  cases  of  psychoses,  nervousness, 
sciaticas,  neuralgia,  spinal  pains,  cervicobrachial  neuritis,  and 
the  like  which  have  come  under  observation  after  such  treat- 
ment had  proved  futile. 

"I  am  glad  to  see  a  growing  skepticism  with  regard  to 
Wassermann  tests.  They  are  of  real  value  as  corroborative  of 
clinical  findings ;  but  when  these  are  in  doubt,  the  Wassermann 
tests  should  be  controlled  by  reports  from  three  dififerent 
laboratories.  It  is  not  long  since  a  single  laboratory  test  was 
considered  final,  and  that  despite  the  presence  or  lack  of 
clinical  evidence." 

FAILURE  TO   DISTINGUISH   BETWEEN   THERA- 
PEUTICS AND   SOUND   PUBLIC   HEALTH 
MEASURES 

The  reports  and  proceedings  of  the  various  municipal, 
state  and  Federal  public  health  activities  show  a  failure  to 
properly  differentiate  between  the  individual  relations  exist- 
ing in  the  practice  of  the  healing  art  and  the  public  relations 
existing  in  the  carrying  out  of  sound  public  health  measures. 

This  is  shown  by  the  repeated  requests  for  vast  appropria- 
tions for  the  alleged  purpose  of  protecting  the  public  health 
but  in  reality  to  furnish  medical  treatment  and  medical  ad- 
vice by  physicians  or  nurses  and  medical  supplies  to  the 
public. 

It  is  also  shown  by  the  character  of  the  publications 
issued  by  our  various  public  health  activities.  The  phrase 
"Call  a  Doctor"  is  used  repeatedly  in  these  publications.  This 
phrase  is  made  to  take  its  place  beside  the  "Eat  More  Raisins" 


47 

of  the  raisin  growers'  association  and  the  "Eat  a  Plate  of 
Ice  Cream  Every  Day"  of  the  ice  cream  manufacturers. 

Health  board  publications  are  used  quite  generally  to  de- 
fend and  encourage  the  use  of  sectarian  medical  practices 
such  as  vaccines  and  serums  for  the  prevention  or  cure  of  a 
number  of  diseases.  This  is  illustrated  by  the  efforts  now 
being  made  by  the  United  States  Public  Health  Service  and 
other  Government  health  activities  to  popularize  the  use  of 
the  Schick  Test  and  to  encourage  the  use  of  Toxin-Anti- 
toxin as  an  alleged  protection  for  children  against  diphtheria. 

The  following  article,  for  example,  which  was  published  in 
"Public  Health  Reports",  the  official  weekly  bulletin  of  the 
United  States  Public  Health  Service,  under  date  of  May  16, 
1919  urges  the  widespread  use  of  the  Schick  Test  and  Toxin- 
antitoxin  : 

p.  1049.  "Newer  Methods  of  Controlling  Diphtheria. 

"The  excellent  results  obtained  by  Park  with  routine  Schick 
tests  and  the  subsequent  active  immunization  of  susceptible 
individuals  with  toxin-antitoxin  mixtures  should  lead  to  the 
wider  use  of  these  procedures  for  the  administrative  control 
of  diphtheria.  The  attention  of  State  and  municipal  health 
officers  is  therefore  called  to  the  article  on  page  1063  de- 
scribing the  outfits  supplied  by  various  manufacturers  of  bio- 
logical products  for  making  Schick  tests  and  for  actively 
immunizing  with  toxin-antitoxin  mixtures.  The  widespread 
use  of  the  procedures  mentioned,  especially  where  diphtheria  is 
at  all  prevalent,  would  constitute  a  distinct  advance  in  the 
present  methods  of  controlling  this  disease." 

Five  Deaths  Caused  by  Toxin-Antitoxin. — In  Dallas, 
Texas  where  toxin-antitoxin  was  recently  tried  out  on  a  num- 
ber of  children  there  were  forty  severe  reactions  including 
five  deaths.  The  following  account  of  the  experience  in  Dallas 
was  given  in  the  Journal  of  the  American  Medical  Association 
for  December  6,  1919,  p.  1778 : 

"Deaths  Following  Toxin-Antitoxin. — On  recommenda- 
tion of  the  city  board  of  health  of  Dallas  that  toxin-anti- 


48 

toxin  be  given  as  an  immunizing  agent  against  diphtheria, 
several  hundred  doses  were  administered  by  private  and  mu- 
nicipal physicians.  Forty  severe  reactions  followed  the  ad- 
ministration of  a  particular  series  issued  by  one  manufacturer. 
The  children  who  received  this  series  manifested  a  severe 
reaction  characterized  by  high  fever,  vomiting  and  pain  at 
the  site  of  injection,  which  occurred  a  few  hours  after  ad- 
ministration. Within  forty-eight  hours  the  skin  over  the  site 
of  injection  became  intensely  inflamed;  the  area  extending 
over  the  forearm,  shoulder  and  hand,  and  in  some  cases  across 
the  chest.  Large  vesicles  filled  with  clear  fluid  appeared.  Gener- 
al reaction  subsided  within  four  to  six  days  and  the  local  reac- 
tion within  eight  to  ten  days.  Five  deaths  occurred  in  this 
series  from  twelve  to  sixteen  days  following  the  administra- 
tion of  the  toxin-antitoxin,  death  being  ascribed  to  acute  myo- 
carditis. The  local  reaction  had  disappeared  a  few  days  previ- 
ous to  death.  No  post  mortem  examinations  were  made,  but 
the  symptoms  and  physical  signs  which  occurred  were  due  to 
excessive  amounts  of  toxin.  All  other  series  of  toxin-antitoxin 
issued  by  this  manufacturer  and  all  ordinary  antitoxin 
used  were  found  to  be  harmless  and  not  followed  by  reaction." 


CHAPTER  V 

GERM  THEORY  THE  BASIS  FOR  MUCH  UNJUST 
LEGISLATION 

"With  all  the  wonderful  strides  of  our  science  in  one  hundred 
years,  we  still  have  the  public  as  abjectly  cowed  today,  before  the 
omnipotent  hosts  of  bacteria,  as  it  was  by  the  evil  spirits  and 
ghosts  and  witches  of  a  past  century." — Dr.  Park  L.  Myers,  Toledo, 
Ohio. 

THE  theory  that  minute  organisms  called  "germs"  are  the 
sole  cause  of  certain  diseases  or  what  is  commonly 
known  as  "The  Germ  Theory"  has  been  the  basis  for  numer- 
ous laws,  rules  and  regulations  antagonistic  to  personal  liberty 
such  as  the  forcible  removal  of  consumptives  in  certain  cases 
in  Boston  under  the  ruling  of  the  local  board  of  health,  vac- 
cination as  a  requisite  for  obtaining  an  education  in  some 
states  and  the  compulsory  wearing  of  face  masks  in  public 
places  in  a  few  cities  during  the  epidemic  of  influenza  in  1918. 

Bacteriophobia  and  Health  Board  Folly. — Some  idea  of 
the  character  of  the  regulations  being  proposed  which  are 
based  on  the  germ  theory  may  be  gained  from  the  following 
extracts  from  an  article  by  Dr.  J.  W.  Hodge^ : 

"It  has  been  proposed  and  recommended  that  the  hundreds 
of  thousands  of  consumptives  in  the  United  States  be  removed 
from  their  homes  and  segregated  in  State  sanitoria ;  that  pest- 
houses  for  consumptives  be  established  to  which  these  unfor- 
tunates shall  be  transferred  (by  force  if  necessary),  and  that 
everybody  and  everything  in  the  remotest  degree  related  to 
consumption  be  placed  under  health  board  surveillance;  that 
every  house  in  which  a  consumptive  has  lived  or  died  be  des- 

*"Some  Observations  and  Reflections  on  the  Theory  of  the  Microbic  Origin  of 
Disease."  by  J.  W.   Hodge.  M.  D-    m  the  "Medical  Century,"   March,    1906. 


50 

troyed  by  fire ;  that  the  clothing  of  consumptives  be  ftimig-ated 
and  boiled  before  being  sent  to  the  laundry.  Many  such  pre- 
posterous measures  formulated  by  health-boards,  coupled  with 
their  hysterical  declamations  about  the  communicability  of 
tuberculosis,  have  put  consumptives  before  the  public  in  the 
attitude  of  criminals,  besides  inflicting  upon  this  class  of  pa- 
tients many  other  genuine  hardships. 

"It  has  been  recommended  that  all  domestics  be  examined 
by  official  inspectors  before  being  admitted  into  a  household ; 
that  all  school  pupils  have  their  throats  officially  inspected 
every  morning  before  entering  school ;  that  all  the  children  in 
our  public  schools  be  injected  at  stated  intervals  with  antitoxin 
in  order  to  immunize  them  against  diphtheria;  that  it  is  dan- 
gerous for  even  a  healthy  person  to  spit  upon  the  sidewalks ; 
that  it  is  not  safe  for  men  to  wear  whiskers ;  that  it  is  danger- 
ous to  frequent  the  town  post-office  or  the  court-room  unless 
these  are  daily  disinfected;  that  it  is  not  safe  to  enter  a  de- 
partment store,  a  theater  or  a  trolley  car  that  is  not  daily 
fumigated;  that  it  is  dangerous  to  receive  letters  written  by 
a  consumptive,  or  handled  by  consumptive  clerks  or  carriers ; 
that  it  is  not  safe  to  use  plates,  cups,  knives,  forks,  or  spoons 
in  restaurants  or  hotels  because  the  simple  rinsing  of  these 
articles  in  boiling  water  is  not  sufficient  to  kill  the  microbes; 
that  it  is  not  safe  to  drink  water  Vv^hich  has  not  been  sterilized ; 
that  it  is  unsafe  to  eat  vegetables  that  have  not  been  washed 
in  sterilized  water;  that  it  is  dangerous  to  eat  the  flesh  of  the 
bovine  species  until  it  has  been  cooked  sufficiently  to  destroy 
the  tubercle  bacilli ;  that  for  the  same  reason  it  is  dangerous 
to  eat  butter,  cheese,  cream  or  milk  that  has  not  been  Pasteur- 
ized.    .     .     " 

Medical  Profession  Not  Unanimous  In  Acceptance  of  the 
Germ  Theory. — In  another  article  on  the  subject  of  "Bac- 
teriophobia  and  Medical  Fads'V  Dr.  Hodge  calls  attention  to 
the  fact  that  the  medical  profession  is  not  unanimous  in  ac- 
ceptance of  the  germ  theory;  that  the  theory  of  the  bacterial 

^Reprint  from  the  Daily  Cataract  Journal,  of  July  22,  1905. 


51 

origin  of  disease  has  become  a  source  of  terror  to  the  non- 
medical world ;  and  that  in  his  opinion  the  germs  are  there  as 
scavengers,  as  friends  to  the  patient  and  as  foes  to  the  disease. 
He  says: 

"There  is  a  popular  impression  among  the  misinformed 
that  the  medical  profession  is  unanimous  in  its  acceptance  of 
the  germ-theory  of  disease,  that  is,  the  theory  that  all  infec- 
tious and  most  other  diseases  are  due  to  the  entrance  of  liv- 
ing micro-organisms  into  the  bodies  of  those  affected.  This 
impression  is  grossly  erroneous.  Many  of  the  most  advanced 
thinkers  in  the  medical  profession,  both  in  this  country  and 
abroad,  are  frank  in  the  expression  of  their  convictions  that 
the  germ-theory  has  no  scientific  basis  upon  which  to  rest  its 
claims.  It  is  a  mere  fantasy  of  fussy  microscopists  who  know 
little  or  nothing  of  the  real  nature  of  disease.  Moreover, 
many  investigators  who  were  at  one  time  identified  with  the 
germ-theory,  are  now  on  record  as  having  abandoned  it  as 
untenable.  For  instance,  at  the  13th  triennial  session  of  the 
International  Medical  Congress,  held  in  Paris  in  1903,  Dr. 
Rudolph  Virchow,  who  is  conceded  to  be  the  world's  leading 
authority  on  this  subject,  frankly  said :  'Microbes  are  always 
found  where  there  is  disease.  They  are  also  found  where 
there  is  no  appreciable  disease,  and  may  be  the  result  and  not 
the  cause  of  disease.'  This  statement  coming  from  one  who 
was  formerly  a  leading  advocate  of  the  germ-theory,  is  signifi- 
cant indeed 

"When  .  .  .  Robert  Koch,  announced  his  germ-theory  he 
added  a  new  and  heavy  burden  to  the  many  with  which  suf- 
fering humanity  was  already  afflicted.  A  few  decades  ago 
the  world  was  in  blissful  ignorance  of  microbes.  Now  the 
microbe  is  here,  there  and  everywhere,  in  all  that  we  eat  and 
drink  and  wear,  in  the  air  we  breathe,  in  the  smoke  and  the 
dust,  in  the  garbage,  on  the  tools  we  use,  and  in  the  ground 
we  tread,  making  of  life  an  apprehensive  possibility  and  a 
galling  suspicion.  By  the  announcement  of  the  discovery  of 
the  disease-germ,  a  new  source  of  anxiety  was  added  to  hu- 


62 

man  existence,  and  this  anxiety  is  all  the  more  burdensome 
because  the  object  of  it  is  unseen  and  one  cannot  tell  at  what 
instant  he  may  be  exposing  himself  to  its  insidious  attacks. 
The  theory  of  the  bacterial  origin  of  disease  has  become  a 
source  of  terror  to  the  non-medical  world.  Thousands  of 
timid  and  weak-minded  people  make  themselves  miserable 
by  a  constant  dread  lest  they  be  surreptitiously  attacked  by 
these  omnipresent  but  invisible  enemies ;  not  daring  to  drink 
a  glass  of  water  or  a  cup  of  milk  unless  it  has  been  boiled  or 
sterilized  in  order  to  destroy  the  dreaded  foe.  These  are  the 
very  people  who  fall  easy  victims  to  typhoid  fever,  cholera 
and  other  so-called  germ-diseases.  I  am  convinced  that  it  is 
not  the  germ  but  the  fear  thereof  that  is  responsible  for  the 
undoing  of  these  timid  and  weak-minded  people. 

"Again,  it  is  a  v/ell  known  fact  that  all  mucous  orifices  of 
the  body,  even  of  healthy  persons,  swarm  with  pathogenic 
bacteria  of  many  descriptions,  some  of  them  being  of  the 
supposed  most  virulent  character.  But  someone  asks :  'Do 
you  deny  the  existence  of  germs?'  I  answer  'No.'  The  germ 
is  a  fact,  a  fact  of  great  interest  to  the  biologist,  but  of  little 
importance  to  the  pathologist.  Germs  are  a  physiological  fact, 
but  the  attempt  to  consign  them  to  the  domain  of  pathology  is 
a  libel  on  these  tiny  harmless  creatures  which  swarm  in  all 
vital  air,  in  all  sparkling  drinking  water,  in  all  wholesome  food, 
and  in  ever}^  healthy  tissue  of  our  bodies.  Again  somebody 
asks :  'Do  we  not  find  germs  in  diseased  as  well  as  in  healthy 
tissues  ?'  Again,  I  answer  'Yes.'  They  are  there  as  scavengers, 
as  friends  to  the  patient  and  as  foes  to  the  disease.  To  charge 
them  with  having  caused  the  disease  would  be  as  unfair  to 
them  as  it  would  be  unjust  to  charge  the  street  scavenger  with 
having  produced  the  filth  which  he  is  engaged  in  removing.  .  " 

Official  Medical  Journal  Warns  Against  the  Dread  of 
Microbes. — The  Journal  of  the  American  Medical  Associa- 
tion, in  a  lengthy  editorial  entitled,  "Germophobia"  called  at- 
tention to  the  absurd  extremes  to  which  the  germ  theory  has 


53 

been  carried  stating  that  "an  insane  terror  of  infection  n.'ay 
make  life  very  miserable  without  appreciably  lengthening  or 
strengthening  it."  It  said^ : 

"The  development  of  the  science  of  baclsriology  has  given 
rise  to  a  new  type  of  'phobia — the  dread  of  microbes.  That 
vague  dread  of  the  mysterious  and  unseen  or  unknown  which 
formerly  attached  to  gnomes  and  kobolds  now  surrounds 
microzoa  and  bacteria,  beings  as  invisible  to  the  unaided  eye  of 
flesh  and,  to  the  popular  fancy,  ten  times  as  full  of  maleficent 
power.  The  very  word  'microbe' — innocent  enough  in  its 
definition  of  'a  little  living  being' — has,  in  the  minds  of  most 
persons,  an  ill-defined  malign  implication.  Science  itself  has 
encouraged,  though  without  design,  this  one-sided  view  of  the 
activities  of  micro-organisms,  for,  naturally,  the  pathogenic 
germs  have  been  studied  before  the  non-pathogenic,  and  large- 
ly to  the  exclusion  of  the  latter.  Popular  writing,  moreover, 
usually  exaggerates  and  often  distorts  the  obvious  trend  of 
science. 

•f*         *?•         'I*         'J' 

"An  aversion  to  unnecessary  contamination  by  noxious 
micro-organisms  may  well  serve  as  a  protection  against  dis- 
ease; but  an  insane  terror  of  infection  may  make  life  very 
miserable  without  appreciably  lengthening  or  strengthening  it. 
In  the  first  place,  the  paradise  of  faultless  prophylaxis — the 
aseptic  Eden  which  seems  to  be  the  ideal  of  the  germophobes — 
is  unattainable.  We  cannot  banish  micro-organisms  from  our 
human  world;  we  can  only  try  to  keep  that  balance  of  condi- 
tions most  favorable  to  the  life  of  the  human  organism.  In 
the  second  place,  the  attitude  of  mind  cultivated  in  the  per- 
petual endeavor  to  evade  disease  may  be  almost  a  worse  evil 
than  the  disease  itself.  .  ." 

Says  People  Have  Been  Frightened  Into  Panicky  Laws. 
—In  a  paper  entitled  "Where  We  Skid'"  Dr.  Park  L.  Myers 

^Editorial  in  Journal  of  the  American  Medical  Association,  January  8,  1910, 
pp.  135-136. 

i"Where  We  Skid,"  by  Dr.  Park  L.  Myers  before  the  Pjdiatric  Section  of  the 
Ohio  State  Medical  Association  and  published  in  the  Oiio  State  Medical  Journal, 
February  IS,  1907. 


34 

referred  to  the  hysteria  created  over  bacteria  and  asks  if  they 
had  not  better  hedge  a  Httle  "before  the  great  lay  mind  grasps 
the  fact  that  they  were  frightened  into  panicky  laws  and  re- 
strictions over  wil-o'-wisp  possibilities  and  not  probabilities  or 
actualities."    He  says: 

"There  is  another  department  in  which  I  fear  we  are  suf- 
fering a  skid  in  our  auto  of  medical  progress. 

"We  have  become  exhilerated  and  enthused  in  our  chase 
of  him  or  it.  We  have  described,  in  lurid  John-Smith-Six- 
teenth century  terms,  the  deadly  characteristics,  the  omni- 
presence, the  elusiveness,  the  omnivorousness,  until  we  have 
worked  ourselves  into  an  oratorical  frenzy  and  our  public  into 
a  veritable  bacteriophobia. 

"In  our  pursuit  of  the  bacteria,  his  habitat,  his  cultural 
growth,  his  loves  of  reds  and  blues  and  his  pathologies — we 
have  rushed  across  the  middle  of  the  boulevards  of  scientific 
truthful  good,  and  are  mighty  close  onto  the  opposite  curb. 

"Should  we  not  veer  a  little? 

"Had  we  not  better  hedge  a  little  before  the  great  lay  mind 
grasps  the  fact  that  they  were  frightened  into  panicky  laws 
and  restrictions  over  wil-o'-wisp  possibilities,  and  not  proba- 
bilities or  actualities? 

"Thus,  I  believe  that  the  effect  of  worry  and  exhaustion 
on  the  rabbit  and  of  cold  on  the  chicken  (as  told  in  all  classi- 
cal texts  on  bacteria),  prove  beyond  all  cavil  the  co-impor- 
tance, the  superior  importance,  of  tissue  reaction  over  powers 
of  infection;  that  with  our  knowledge  of  bacteria,  the  fear 
and  danger  of  all  disease  ought  to  be  much  less;  in  fact,  as 
much  less  as  our  knowledge  is  more  exact,  as  to  facts  of 
bacteria  growing  and  killing. 

'T  believe  that  the  enforcement  of  stringent  quarantines 
by  startling  placards  or  uniformed  police,  and  particularly 
the  rush  and  enforced  privacy  of  funeral  ceremonies  are  all 
but  a  sinister  reflection  upon  the  truth  of  our  claims  of  our 
power  to  destory  bacteria  by  fumigation. 

"With  all  the  wonderful  strides  of  our  science  in  one  hun- 


55 

dred  years,  we  still  have  the  public  as  abjectly  cowed  today, 
before  the  omnipotent  hosts  of  bacteria,  as  it  was  by  the  evil 
spirits  and  ghosts  and  witches  of  a  past  century." 


CHAPTER  VI 

FALLACY  OF  PLEA  FOR  MEDICAL  CONTROL 
THROUGH  MEDICAL  PRACTICE  ACTS 

"When  a  doctor  notes  what  he  considers  good  effects  from  his 
own  practice,  it  is  natural  for  him  to  let  well  enough  alone,  and 
refrain  from  exploring  unknown  lines.  Here,  as  elsewhere,  indi- 
vidual success  goes  the  better  for  a  certain  narrowness,  which 
therefore  is  not  wholly  evil.  But  when  ignorance  snd  narrowness, 
instead  of  being  humble,  g'row  insolent  and  authoritative,  and  ask 
for  laws  whose  only,  immediate  result  can  be  to  consecrate  and 
perpetuate  them,  then  I  think  that  every  citizen  interested  in  the 
growth  of  a  genuinely  complete  medical  science  should  rise  up  and 
protest." — The  Late  Professor  William  James. 

T  the  present  time  a  number  of  states  have  medical  prac- 
tice acts  now  in  force  requiring  applicants  for  a  license 
to  practice  medicine  and  surgery  to  pass  an  examination  before 
a  medical  licensing  board ;  applicants  for  a  license  to  practice 
osteopathy  to  pass  an  examination  before  an  osteopathic  licens- 
ing board,  and  applicants  for  a  license  to  practice  chiropractic 
to  pass  an  examination  before  a  chiropractic  board.  The 
question  of  whether  or  not  such  legislation  has  a  tendency  to 
elevate  the  respective  systems  above  referred  to  or  to  protect 
the  public  against  incompetent  practitioners  is  not  here  entered 
into. 

The  purpose  of  this  chapter  is  to  show  the  fallacy  of  the 
plea  on  vv'hich  a  single  school  of  heahng  (the  Allopathic)  bases 
its  demand  for  further  and  more  restrictive  legislation,  with 
the  object  of  suppressing  the  practice  of  all  other  systems  of 
healing.  It  will  show  that  the  use  of  the  medical  practice  act 
as  a  weapon  with  which  to  keep  competitors  from  minister- 
ing to  the  sick  and  preventing  the  public  from  having  the 
benefit  of  their  professional  services  constitutes  a  vicious  and 
wholly  illegitimate  use  of  the  medical  practice  act. 


67 

Practice  of  "Regular"  Physicians  Is  Exclusive. — One  ot 

the  favorite  expressions  of  those  seeking  to  gain  complete 
control  of  the  healing  art  under  the  plea  of  protecting  the 
public  health  is  set  forth  in  a  recent  memorandum^  by  former 
Surgeon-General  Gorgas  to  the  Adjutant-General  of  the 
Army.  While  it  is  specious  and  unsound  it  is  plausible  and 
is  usually  accepted  as  conclusive.  So  much  so  that  it  is  be- 
lieved that  the  exponents  of  organized  medicine  have  come  to 
believe  it  themselves.    It  is  as  follows: 

"The  time  has  long  passed  for  exclusive  adherence  to  any 
particular  school  of  medical  doctrine  or  practice,  such  as  is 
implied  by  the  degree  of  doctor  of  osteopathy,  of  chiropractic, 
of  naturopathy,  of  mechanotherapy,  of  eclectic  medicine,  or 
any  other  'pathy.'  The  terms  'allopathy.'  'old  school,'  etc.  are 
equally  objectionable.  A  scientifically  educated  physician  is  at 
liberty,  and  it  is  his  duty  to  employ  any  method  of  treatment 
whatever  which  he  believes  will  benefit  his  patient." 

The  sectarianism  within  the  allopathic  or  so-called  "regu- 
lar" system  of  healing  is  brought  out  very  clearly  in  the  fol- 
lowing extrapts  from  an  address  by  the  late  Professor  Wil- 
Ham  James  of  Harvard  College  regarding  the  exemption  of 
the  mind-curers  from  the  operation  of  a  drastic  law  pending 
before  the  Massachusetts  legislature^: 

"Were  medicine  at  present  a  finished  science,  with  all 
practitioners  in  agreement  about  methods  of  treatment,  such 
a  bill  as  this,  to  make  it  penal  to  treat  a  patient  without  hav- 
ing passed  an  examination,  would  be  unobjectionable.  But  it 
would  also  be  unnecessary  then.  No  one  would  attempt  to 
cure  people  without  the  instruction  required. 

"But  the  present  condition  of  medical  knowledge  is  widely 
dififerent  from  such  a  state.  Both  as  to  principle  and  as  to 
practice  our  knowledge  is  deplorably  imperfect.  The  whole 


^Published  in  The  Journal  of  the  American  Medical  Association,  May  18,  1918, 
p.    1468. 

'Address  by  Prof.  James  delivered  before  the  Committee  on  Public  Health,  at 
the  State  House,  Boston,  Mass.,  March  2,  1898,  and  published  in  "Banner  of 
Light,"    March    12,    1898. 


58 

face  of  medicine  changes  unexpectedly  from  one  generation 
to  another,  in  consequence  of  widening  experience;  and  as  we 
look  back,  with  a  mixture  of  amusement  and  horror  at  the 
practice  of  our  grandfathers,  so  we  cannot  be  sure  how  large 
a  portion  of  our  present  practice  will  awaken  similar  feelings 
in  our  posterity. 

"Each  generation  adds  something,  it  is  to  be  hoped,  to  the 
treatment  that  will  not  pass  away.  Few  of  us  recall  the  intro- 
duction of  the  water-cure,  but  many  now  living  can  recall 
the  discovery  of  anesthetics.  Most  of  us  recollect  when  medi- 
cal electricity  and  massage  came  in,  and  we  have  all  witnessed 
the  spreading  triumphs  of  antiseptic  surgery,  and  are  now 
hearing  of  the  antitoxins  and  of  the  way  in  which  hypnotic 
suggestion,  and  all  the  other  purely  mental  therapeutic 
methods,  are  achieving  cures. 

"Some  of  these  therapeutic  methods  arose  inside  of  the 
regular  profession;  others  outside  of  it.  In  all  cases  they 
have  appealed  to  experience  for  their  credentials.  But  experi- 
ence in  medicine  seems  to  be  an  exceedingly  difficult  thing. 
Take  homeopathy,  for  instance,  now  nearly  a  century  old.  An 
enormous  mass  of  experience,  both  of  homeopathic  doctors 
and  their  patients,  is  invoked  in  favor  of  the  efficiency  of 
these  remedies  and  doses.  But  the  regular  profession  stands 
firm  in  its  belief  that  such  experience  is  worthless,  and  that 
the  whole  history  is  one  of  quackery  and  delusion.  In  spite 
of  the  rival  schools  appealing  to  experience,  their  conflict  is 
much  more  like  that  of  two  philosophers  or  two  theologists. 
Your  experience,  says  one  side  to  the  other,  simply  isn't  fit  to 
count. 

"So  we  have  great  schools  of  medical  practice,  each  with 
its  well-satisfied  adherents,  living  on  in  absolute  ignorance  of 
each  other  and  each  other's  experience.  How  many  of  the 
graduates,  recent  or  early,  of  the  Harvard  Medical  School 
have  spent  twenty-four  hours  of  their  lives  in  experimentally 
testing  homeopathic  remedies,  or  seeing  them  tested?  Prob- 
ably not  ten  in  the  whole  Commonweath.    How  many  of  my 


59 

learned  medical  friends,  who  today  are  so  freely  denouncing 
mind-cure  methods  as  an  abominable  superstition,  have  taken 
the  pains  to  follow  up  the  cases  of  some  mind-curer,  one  by 
one,  so  as  to  acquaint  themselves  with  the  results?  I  doubt 
if  there  be  a  single  individual.  Of  such  experience  as  that, 
they  say,  'Give  me  ignorance  rather  than  knowledge.'  And 
the  Club-opinion  of  the  Massachusetts  Medical  Society  pats 
them  on  the  head  and  backs  them  up.  I  don't  blame  any  set 
of  practitioners  for  remaining  ignorant  of  all  practice  but 
their  own.  The  subject  is  too  overwhelmingly  great.  It  takes 
an  entire  life  to  gain  adequate  experience  of  a  few  diseases 
and  a  few  remedial  methods.  When  a  doctor  notes  what  he 
considers  good  effects  from  his  own  practice,  it  is  natural  for 
him  to  let  well  enough  alone,  and  refrain  from  exploring  un- 
known lines.  Here,  as  elsewhere,  individual  success  goes  the 
better  for  a  certain  narrowness,  which  therefore,  is  not  wholly 
evil.  But  when  ignorance  and  narrowness,  instead  of  being 
humble,  grow  insolent  and  authoritative,  and  ask  for  laws 
whose  only  immediate  result  can  be  to  consecrate  and  per- 
petuate them,  then  I  think  that  every  citizen  interested  in  the 
growth  of  a  genuinely  complete  medical  science  should  rise 
up  and  protest. 

"In  the  matter  of  pharmacy,  in  the  matter  of  such  an  art 
as  plumbing,  the  legislature  may  impose  examination  and  grant 
license  without  harm.  The  facts  are  here  ultra  simple  in  com- 
parison, and  no  differences  whatever  of  conscientious  opinion 
among  the  experts  as  to  what  is  right.  But  this  case  of 
medical  practice  is  absolutely  different.  It  is  the  confusion, 
the  deplorable  imperfection  of  the  most  expert  knowledge, 
and  the  conscientious  divergences  of  opinion,  the  infinite 
complication  of  the  phenomena,  and  the  varying  and  mu- 
tually-exclusive fields  of  experience,  that  are  the  very  es- 
sence of  the  case. 

^        5p        :|C        5jc 

"The  blindness  of  a  type  of  mind  is  not  diminished  when 


60 

those  who  have  it  band  themselves  together  in  a  corporate 
profession.  By  just  as  much  as  they  hold  each  other  to  be 
thorough  and  conscientious  there,  by  just  so  much  along  the 
other  lines  do  they  not  only  permit  but  even  compel  each  other 
to  be  shallow.  When  I  was  a  medical  student  I  feel  sure  that 
any  one  of  us  would  have  been  ashamed  to  be  caught  looking 
into  a  homeopathic  book  by  a  professor.  We  had  to  sneer  at 
homeopathy  by  word  of  command.  Such  was  the  school 
opinion  at  that  time,  and  I  imagine  that  similar  encouragements 
to  superficiality  in  various  directions  exist  in  the  medical 
schools  of  today.  *  *  *  * 

"The  hinge  of  my  whole  contention,  you  see,  is  that  in  strict- 
ly medical  quarrels  the  state  has  no  right  to  interfere." 

Training  In  Medical  Diagnosis  No  Criterion  For  Prac- 
tice Of  Healing  Art. — Another  claim  frequently  advanced 
in  favor  of  the  medical  control  of  the  practice  of  the  healing 
art  is  that  all  practitioners,  no  matter  what  system  they  use, 
should  be  trained  in  medical  diagnosis,  the  assumption  being 
that  those  who  have  had  a  medical  training  are  able  to  tell 
what  is  wrong  with  the  patient  and  that  they  are  the  only  ones 
who  can  do  so.  This  claim  is  expressed  in  the  following  ex- 
tract from  an  article  under  "Current  Comment"  in  the  Jour- 
nal of  the  American  Medical  Association  for  August  24,  1912 : 

*Tn  the  treatment  of  human  ailments,  the  matter  of  first 
importance  to  the  conscientious  physician  is  the  diagnosis: 
'what  is  causing  the  trouble  ?'  On  the  answer  to  this  question 
depends  the  treatment,  no  matter  whether  the  'doctor'  is  a 
regular  physician,  an  eclectic,  an  osteopath,  a  homeopath,  a 
chiropractic,  a  Christian  Scientist,  a  mental  healer  or  what 
not.  The  first  essential  is  the  diagnosis ;  and  unless  the  'doc- 
tor' is  sufficiently  well  trained  in  the  fundamental  medical 
sciences  to  make  a  diagnosis,  he  is  not  qualified  to  treat  the 
patient  intelligently  by  any  method  whatever.  Treatment  is 
certainly  of  great  importance,  and  from  the  patient's  point  of 
view  is  doubtless  the  most  essential  point.  But  without  a 
knowledge  of  the  disease — of  the  actual  condition — any  treat- 


61 

ment  would  be  pure  guesswork,  unscientific  and  as  liable  to 
do  harm  as  good." 

Inasmuch  as  each  system  of  healing  explains  the  cause  of 
diseases  in  a  different  way  it  would  be  just  as  unjust  and  un- 
American  for  the  Government  to  require  that  all  persons  who 
practice  the  healing  art  diagnose  in  the  same  way  as  it  would 
be  to  require  that  they  administer  the  same  kind  of  treatment. 

In  the  preceding  chapter  attention  was  called  to  the  fact 
that  there  is  a  wide  difference  of  opinion,  even  within  the 
medical  profession,  as  to  whether  or  not  germs  are  the  cause 
of  all  infectious  and  most  other  diseases. 

No  one  questions  the  importance  of  finding  out  "What 
is  causing  the  trouble?"  The  practitioners  of  one  system  of 
healing  are  just  as  interested  in  that  as  the  practitioners  of 
another  system.  They  all  differ  very  widely,  however,  as  to 
what  constitutes  the  basis  for  disease, — whether  it  be  physical 
or  metaphysical;  chemical  or  bacteriological;  or  any  one  of 
the  numerous  other  bases  which  are  claimed  to  be  the  cause 
of  disease.  The  following  extract  from  an  address  by  ECr. 
Richard  C.  Cabot  is  an  illustration  of  how  different  bases 
are  used  in  endeavoring  to  determine  "What  is  causing  the 
trouble  ?"i: 

"We  read  that  certain  criminologists  have  by  long  study  and 
examination  found  what  they  consider  to  be  definite  physical 
evidence  of  a  criminal  build,  certain  abnormalities  of  skull, 
ears,  palate,  etc.,  and  that  the  main  thing  to  do  is  to  study 
the  physical  man  if  you  wish  to  determine  his  guilt  and  plan 
his  treatment.  It  matters  not  that  every  prison  official  with 
long  experience  in  caring  for  criminals  says  that  this  is  not  so, 
and  that  these  supposed  'stigmata'  are  not  characteristic. 
Never  mind.  We  must  have  some  explanation,  easy  and 
quick,  and  therefore  seize  upon  the  physical  conception  of 
criminology. 


'Address  by  Dr.  Cabot,   entitled  "The  Consecration  of  the  Affactions,"  befor* 
the  American  School  Hygiene  Association.  February  3.   1911. 


62 

"The  problem  of  the  backward  child  is  brought  before  us : 
we  face  a  great  spiritual  puzzle  and  we  solve  it  in  the  same 
hurried  manner.  We  say:  'Cut  out  the  child's  adenoids  and 
the  trouble  will  cease.'  Now-  and  then  that  is  true.  Sometimes 
the  child  is  brighter  and  better  after  the  adenoid  operation. 
But  it  is  always  easier  to  cut  out  the  tonsils  than  to  face  the 
whole  problem  of  why  that  child  is  backward  and  what  are 
the  circumstances  leading  up  to  his  condition  at  this  moment; 
so  we  send  for  the  doctor,  have  the  operation  done  and  feel 
relieved.  But  in  many,  many  cases  the  backward  child  is 
there  just  the  same,  and  will  be  there  until  we  recognize  the 
spiritual  problem  of  his  individuality.  The  average  child  re- 
sponds to  average  methods  of  teaching  and  those  methods 
come  to  be  accepted  as  standard.  But  there  are  others  who 
are  intelligent,  yet  cannot  learn  by  the  regular  methods  suited 
to  the  majority.  These  special  children  need  special  study  and 
special  ingenuity,  and  we  shrink  from  the  task.  It  is  much 
easier  to  say  that  they  have  adenoids" 

The  methods  used  by  allopathic  or  so-called  "regular" 
physicians  are  constantly  changing.  This  is  pointed  out  in  the 
following  extracts  from  an  article  by  Dr.  Joseph  Zeisler  en- 
titled "Our  Tendency  to  Fads"  appearing  in  the  Journal  of 
the  American  Medical  Association  August  9,  1913 : 

"Not  only  in  regard  to  therapeutics  do  we  find  a  ten- 
dency to  fads.  \Ye  can  observe  a  similar  tendency  in  regard 
to  broad  pathologic  and  diagnostic  questions.  There  was  a 
period  in  dermatology  when  an  attempt  was  made  to  explain 
most  skin  diseases  of  unknowm  etiology  on  the  basis  of  tro- 
phoneurotic influences.  That  was  at  the  time  before  bac- 
teriology had  become  estabhshed  in  its  varied  etiologic  rela- 
tions. More  recently  the  subject  of  anaphylaxis  has  been 
forced  into  the  foreground  and  is  being  discussed  to  an  ex- 
tent and  used  to  explain  the  cause  of  disease  in  a  maimer 
which  classes  it  among  the  fads." 

In  an  article  appearing  in  The  Journal  of  the  American 
Medical  Association  for  May  20,  1916,  Dr.  Ludvig  Hektoen, 


08 

Giicago,  calls  attention  to  the  advocacy  and  later  abandon- 
ment of  the  opsonic  index.    He  says: 

"In  the  early  days  after  Wright's  discovery  of  the  opsonins 
and  his  advocacy  of  specific  vaccine  treatment  under  the 
guidance  of  the  opsonic  index,  much  attention  was  given  to 
this  index  as  a  measure  of  specific  resistance  and  in  less  de- 
gree as  a  means  of  diagnosis.  Soon  doubts  arose  as  to  the 
value  of  the  index;  the  accuracy  of  the  method  was  ques- 
tioned, and  emphasis  was  put  on  the  limitations  of  the  results 
as  not  being  a  measure  of  the  final  degree  of  immunity  be- 
cause applicable  to  one  factor  only,  leaving  unmeasured  other 
factors  equally  important  and  not  necessarily  subject  to  paral- 
lel fluctuations  of  activity.  The  outcome  was  the  abandon- 
ment of  the  index  as  an  essential  element  in  vaccine  treat- 
ment, which  in  the  meantime  rapidly  passed  into  general  use 
and,  at  least  in  this  country,  soon  became  the  object  of  an 
unrestrained  and  indiscriminate  exploitation,  to  which  the 
medical  profession  has  offered  but  little  resistance." 

The  large  percentage  of  wrong  diagnoses  by  "regular" 
physicians  is  discussed  at  length  in  the  following  chapter.  It 
shows  that  the  average  diagnosis  by  the  allopathic  or  so-called 
"regular"  physician  is  so  unreliable  that  it  is  regarded  as  only 
a  matter  of  opinion. 

Scholarship  Not  The  Final  Criterion. — ^The  fallacy  of  the 
contention  that  educational  requirements  are  a  proper  cri- 
terion for  regulating  the  practice  of  the  healing  art  is  brought 
out  by  the  following  declaration  by  Dr.  Frederick  Peterson  in 
an  article  in  the  Journal  of  the  American  Medical  Association 
for  December  6,  1919 : 

"  General  intelligence,  even  great  scholarship  in  all  direc- 
tions outside  of  medicine,  is  no  criterion  for  judgment  in  the 
matter  of  means  and  methods  for  curing  disease.  Of  Berke- 
ley, o3ie  of  the  greatest  minds  of  England,  a  philosopher,  a 
scholar,  it  was  said,  'Ancient  learning,  exact  science,  polished 
society,  modern  literature,  and  the  fine  arts  contributed  to 
adorn  and  enrich  the  mind  of  this  accomplished  man.'     He 


was  a  distinguished  bishop  as  well  as  an  illustrious  scholar. 
But  he  discovered  an  eHxer  of  life  made  by  mixing  a  gallon 
of  water  with  a  quart  of  tar,  leaving  it  for  48  hours,  and 
pouring  off  the  clear  water.    *    *     * 

"The  same  psychologic  factors  are  at  work  in  us  as  in  the 
general  public  for  the  creation  of  faith  in  the  new  drug  or  in 
the  new  method.  We  do  not  know  enough  about  it  to  be  suf- 
ficiently critical.  This  ignorance  of  ours  prepares  the  ground 
for  the  new  belief,  the  new  conviction.  Its  value  is  asserted 
by  authority.  And  we  are  eager  to  believe  in  the  new  hope 
of  help  held  out  to  us  for  the  healing  of  the  sick.  Then, 
again,  there  are  the  marvelous  mysteries  behind  all  the  new 
names — harmones,  opsonins,  endocrines,  amboceptors,  etc. — 
such  a  wide  field  for  new  facts,  such  a  vast  horizon  for  new 
theories.  We  can  hardly  be  blamed  for  not  being  always 
able  to  get  our  bearings  in  these  uncharted  seas." 


CHAPTER  VII 

MEDICAL  EXAMINATION  OF  SCHOOL  CHILDREN 

INEFFECTIVE  AND  IN  MANY  CASES 

ACTUALLY  HARMFUL 


"It  is  the  plain  duty  of  the  school  authorities  to  see  to  it  that  the 
school  buildings  and  all  places  where  the  students  assemble  for  study 
are  safe,  sanitary,  comfortable,  well  lighted  and  ventilated,,  and  in 
every  way  suitable  and  calculated  to  facilitate  and  promote  the 
work  to  be  there  performed.  When  they  assume  to  go  beyond  this, 
and  to  take  charge  of  the  physical  condition  and  health  of  the  pupil 
we  believe  they  have  transcended  their  functions.  This  duty  should 
be  left  to  the  parent  or  legal  guardian,  where  it  properly  belongs. 
Furthermore,  although  there  may  be  exceptional  cases  and  locali- 
ties, we  should  say  as  a  general  rule  that  if  the  duty  of  looking 
after  the  health  and  physical  condition  of  the  child  is  taken  from 
the  parent  and  his  chosen  physician  and  delegated  to  the  school, 
it"  is  not  likely  to  be  so  well  performed." — William  Nottingham, 
M.  A.,  Ph.  D.,  LL.  D.,  a  Regent  of  the  University  of  the  State  ot 
New  York. 

MISTAKES  In  Diagnosis  Not  Uncommon. — As  physi- 
cians themselves  admit  that  even  within  our  largest 
hospitals  they  are  unable  to  diagnose  more  than  approxi- 
mately fifty  per  cent  of  advanced  cases  correctly,  the  em- 
ployment of  physicians  in  the  public  schools  to  examine  the 
children  for  incipient  cases  must  be  a  waste  of  time  and 
money. 

The  following  table^  by  Dr.  Cabot  was  prepared  from  a 
study  of  3,000  autopsies.  It  gives  the  correct  diagnoses  as 
ranging  from  16  per  cent  in  acute  nephritis  to  95  per  cent  in 
diabetes  mellitus.  The  general  average  for  the  twenty-eight 
diseases  given  is  53.5  per  cent: 


^"Diagnostic  Pitfalls  Identified  During  a  Study  cf  Three  Thousand  Autopsies,** 
by  Dr.  Richard  C.  Cabot,  Assistant  Professor  of  Aledicine,  Harvard  University, 
in  the  Journal  of  the  American   Medical   Association,   December  28,   1912. 


66 

p.  2296.    "TABLE  SHOWING  PERCENTAGE  OF  COR- 
RECT DIAGNOSES  IN  VARIOUS  DISEASES 

Diabetes  Mellitus,  95%  Chronic     Interstitial     Nephritis, 
Typhoid,   92%  50% 

Aortic  Regurgitation,  84%  Thoracic  Aneurysm,  50% 

Cancer  of  Colon,  74%  Hepatic  Cirrhosis,  39% 

Lobar  Pneumonia,  74%  Acute  Endocarditis,  39% 
Chronic  Glomerulonephritis,  74%      Peptic  Ulcer,  36% 

Cerebral  Tumor,  72.8%  Suppurative  Nephritis,  35% 

Tuberculous  Meningitis,  72%  Renal  Tuberculosis,  33.3% 

Gastric  Cancer,  72%  Bronchopneumonia,  33% 

Mitral  Stenosis,  69%  Vertebral  Tuberculosis,   23% 

Brain  Hemorrhage,  67%  Chronic   Myocarditis,  22% 

Septic  Meningitis,  64%  Hepatic  Abscess,  20% 

Aortic  Stenosis,  61%  Acute   Pericarditis,  20% 

Phthisis,  Active,  59%  Acute  Nephritis,  16% 
Miliary  Tuberculosis,  52% 

The  Report  of  the  Committee  on  Inquiry  into  the  Depart- 
ments of  Health,  Charities,  and  Bellevue  and  Allied  Hospitals 
of  New  York,  1913,  harmonizes  very  closely  in  its  findings 
with  those  of  Dr.  Cabot.  Referring  to  the  Report  the  Jour- 
nal of  the  American  Medical  Association  said^ : 

"Part  III  of  the  Report  of  the  Committee  on  Inquiry  into 
the  Departments  of  Health,  Charities,  and  Bellevue  and  Al- 
lied Hospitals  of  New  York  contains  some  interesting  com- 
parisons of  the  clinical  diagnoses  and  the  necropsy  findings 
in  the  cases  of  patients  dying  in  the  hospital.  The  compari- 
son was  made  from  the  records  by  Dr.  Horst  Oertel,  formerly 
chief  pathologist  of  the  Russell  Sage  Pathological  Institute, 
in  388  cases  in  which  post-mortems  were  held.  In  87  of 
these,  or  22.4  per  cent,  the  clinical  diagnoses  were  confirmed; 
in  116,  or  29.9  per  cent,  the  diagnoses  were  correct  but  the 
necropsies  disclosed  additional  important  lesions;  in  54,  or 
13.9  per  cent,  the  clinical  diagnoses  were  partially  correct  but 
the  necropsies  revealed  other  important  lesions;  in  107,  or 
27.6  per  cent,  the  clinical  diagnoses  were  not  confirmed,  in 
24,  or  6.2  per  cent,  no  clinical  diagnoses  were  recorded  in 

/Article  in  the  Journal  of  the  American  Medical   Association,  entitled   "Clinical 
Diagnoses  and  Necropsy  Findings  in   Bellevue,  April   18,  1914,  p.   1279, 


67 

the  death  records.  The  clinical  diagnoses  were  therefore 
confirmed  in  53.3  per  cent  of  the  cases  and  not  confirmed  in 
47.7  per  cent.  The  conclusions  drawn  by  those  responsible 
for  the  report  are  'not  that  the  findings  of  the  attending  phy- 
sicians at  Bellevue  are  carelessly  made  and  recorded,  but 
rather  that  too  great  reliance  is  placed  on  inexperienced  house 
physicians  and  interns,  and  also  that  the  current  knowledge 
necessary  to  make  clinical  diagnoses  which  shall  approach  ac- 
curacy is  insufficient.'  By  this  is  meant  that  'medical  knowl- 
edge is  not  sufficiently  advanced  to  enable  physicians  to  diag- 
nose with  great  degree  of  accuracy.'     *     *     *  '» 

The  unreliability  of  the  diagnosis  of  incipient  disease  is 
further  brought  out  in  an  article  by  Dr.  Bushnell  in  which  he 
calls  attention  to  the  modern  tendency  of  physicians  to  give 
weight  to  signs  formerly  regarded  as  unimportant  in  the  diag- 
nosis of  tuberculosis,  thereby  branding  the  person  as  having 
tuberculosis  when  he  does  not  have  the  disease.     He  says' : 

"For  some  years  it  has  been  the  aim  of  many  writers  on 
the  diagnosis  of  tuberculosis  to  discover  signs  which  should 
reveal  the  presence  of  tuberculosis  at  a  much  earlier  date  than 
was  possible  by  resort  to  the  commonly  recognized  signs  of 
that  disease.  This  was  based  on  the  theory  that  a  very  early 
diagnosis  would  lead  to  more  speedy  and  certain  cure.  This 
striving  after  new  signs,  or  this  giving  of  a  new  significance 
and  weight  to  signs  formerly  regarded  as  unimportant,  or 
overlooked  entirely,  has  not  been  peculiar,  by  any  means,  to  the 
profession  of  the  United  States.  The  tendency  in  this  direc- 
tion has  been  marked  in  the  medical  writings  of  England, 
France  and  Germany  as  well.     *     *     * 

"Early  in  the  war  it  was  reported,  on  the  authority  of  Lan- 
douzy,  one  of  the  most  prominent  of  French  physicians,  that 
during  the  first  year  of  the  war  86,000  soldiers  were  dis- 
charged from  the  French  army  on  account  of  tuberculosis. 
*     *     *     Major  Rist  examined  various  groups  of  men  sent 

'Article  by  George  E.   Bushnell,   M.  D.,   Colonel,  U.  S.  Army    (Retired)   in  the 
Journal   of  the   American    Medical    Association,    March  9,    |918,   pp.   663-664. 


«5 

back  from  the  front  with  the  diagnosis  of  tuberculosis,  and 
found  the  disease  present  in  less  than  20  per  cent  of  the  cases. 
Blumel,  in  Germany,  also  has  reported  that  of  cases  supposed 
to  require  sanatorium  treatment,  examined  by  him,  less  than 
20  per  cent  had  active  tuberculosis." 

Says  Diagnosis  May  Depend  on  "Psychological  In- 
fluence."— The  Bulletin  of  the  California  State  Board  of 
Health  January,  1919,  referring  to  measures  adopted  for  the 
control  of  influenza,  stated  that  "not  only  are  morbidity  re- 
ports unreliable,  but  second,  and  most  disquieting  of  all,  the 
fact  is  shown  that  there  was  undoubtedly  a  psychological  in- 
fluence acting  upon  the  medical  profession".  It  offers  a  dia- 
gram showing  how  the  number  of  cases  of  influenza  dropped 
so  that  for  two  weeks  there  were  about  as  many  deaths  occur- 
ring as  there  were  cases  reported,  and  says : 

"That  the  reporting  of  cases,  even  in  San  Francisco,  is  not 
accurate,  is  indicated  by  an  inspection  of  Figure  II,  which 
illustrates  two  things:  First,  that  not  only  are  morbidity  re- 
ports unreliable,  but  second,  and  most  disquieting  of  all,  the 
fact  is  shown  that  there  was  undoubtedly  a  psychological  in- 
fluence acting  upon  the  medical  profession.  This  is  very 
plainly  illustrated.  Following  the  discontinuance  of  masking 
and  the  publication  of  reports  from  the  San  Francisco  De- 
partment of  Health  to  the  effect  that  conditions  were  prac- 
tically normal,  the  cases  reported  daily  fell  to  a  figure  out 
of  all  proportion  to  the  deaths  that  were  occurring  daily. 
There  is  absolutely  no  argument  regarding  the  occurrence  or 
non-occurrence  of  a  death  from  influenza  or  pneumonia  as 
the  State  Registrar  of  Vital  Statistics  has  on  file  the  death 
certificate,  which  is  a  written  record  giving  all  the  details,  in- 
cluding the  actual  date  of  death. 

"There  is  only  one  explanation  for  the  discrepancy  between 
the  case  rates  and  the  death  rates  in  that  part  of  the  curve 
for  November  23  to  November  30,  which  shows  that  for  two 
weeks  there  were  about  as  many  deaths  occurring  as  there 
were  cases  reported.     This  would  indicate  that  physicians,  in 


69 

their  optimism  following  the  subsidence  of  the  main  portion 
of  the  epidemic,  unconsciously  stretched  a  point  in  favor  of 
the  diagnosis  against  influenza.  The  same  explanation  applies 
in  part  to  the  rapid  rise  of  cases  following  the  demand  of  the 
health  officer  for  the  re-enactment  of  a  masking  ordinance,  in 
which  case  the  physicians  were  again  impelled  by  the  psycho- 
logical influence  of  the  non-support  of  the  health  department 
by  the  supervisors,  to  give  the  benefit  of  the  doubt  to  the 
side  of  influenza  in  their  diagnosis." 

Majority  of  Medical  Examinations  "Farcical." — Another 
reason  for  the  unreliability  of  medical  examinations  of  school 
children  is  the  fact  that  parents  do  not  wish  to  have  their 
children  stripped  to  the  waist  for  examination  whereas  med- 
ical inspectors  say  the  children  must  be  examined  in  the  ab- 
sence of  clothing  or  the  examinations  are  worthless.  For 
example,  in  a  syndicated  article  appearing  in  the  Chicago  Daily 
News  for  October  22,  1918,  Dr.  William  Brady,  referring  to 
an  article  by  Dr.  G.  M.  Retan,  school  medical  inspector  in 
Solvay,  N.  Y.,  says : 

"In  Solvay  the  medical  inspector  appears  to  be  a  capable  and 
careful  man.  He  says:  'Of  course,  there  is  no  object  in 
making  an  examination  of  the  child's  lungs  with  the  child 
partly  undressed.  All  manner  of  confusing  sounds  are 
elicited  by  the  rubbing  of  the  stethoscope  on  the  clothing,  and 
again  by  the  rubbing  of  the  clothing  on  the  chest  wall.' 

"Through  a  questionnaire  Dr.  Retan  learned  that  it  was 
the  rule  in  only  fifteen  of  the  seventy-eight  school  districts 
of  the  State  to  examine  the  child  stripped  to  the  waist.  In 
other  words,  the  great  majority  of  medical  inspections  in  the 
public  schools  of  New  York  State  are  farcical  examinations, 
and  a  casual  examination  of  the  official  form  or  blank  pro- 
vided by  the  school  authorities  strongly  suggests  that  farcical 
was  the  adjective  they  had  in  mind  when  they  instituted  the 
system  of  physical  inspection." 

The  Cincinnati  Lancet-Clinic,  on  the  other  hand,  in  an  edi- 
torial April  8,  1911,  criticised  the  attempt  to  require  children 


70 

to  be  examined  stripped  to  the  waist  in  the  Newark  public 
schools  as  follows: 

"The  citizens  of  Newark,  N.  J.,  ought  to  live  for  a  space 
in  monarchical  Prussia  to  realize  what  it  is  to  be  subject  to 
arbitrary  rule  in  the  hospitals  and  schools.  Absolutely  no 
regard  is  said  to  be  paid  there  to  the  demands  of  modesty 
when  a  careful  physical  examination  is  required  to  determine 
a  diagnosis.  In  Newark  the  parents  of  girls  in  the  public 
schools  are  wroth  over  the  recent  rule  promulgated  by  the 
medical  adviser  of  the  local  board  of  education,  to  strip  girls 
from  the  waist  up  to  ensure  a  correct  diagnosis  in  diseases 
of  the  thorax.  The  examining  staff  has  enforced  the  rule, 
taking  groups  of  girls  from  the  class-rooms  and  examining 
them  in  the  presence  of  each  other.  Whenever  a  particu- 
larly refractory  pupil  was  encountered,  she  was  requested  to 
bring  her  mother  to  the  school  the  next  day,  and  in  her  pres- 
ence undergo  the  examination.  There  have  been  many  com- 
plaints made  by  family  physicians  that  girls  were  sent  home 
with  the  request  that  the  doctor  treat  them  for  diseases  which 
upon  closer  examination  were  found  absent,  or  it  was  ascer- 
tained some  other  condition  was  present.  Hence  the  medical 
adviser  of  the  board  insisted  that  a  thorough  examination  be 
made  or  else  to  abandon  altogether  a  useless  medical  inspec- 
tion. The  parents  have  in  general  refused  to  be  educated  to 
the  point  of  seeing  the  justice  of  this,  and  there  you  are !" 

Medical  Examinations  Tend  To  Fasten  Disease  on  Chil- 
dren.— Medical  examinations,  instead  of  being  the  means 
of  guarding  against  disease,  may  bring  about  disease.  Accord- 
ing to  Dr.  Charles  W.  Burr,  Professor  of  Mental  Diseases  in 
the  University  of  Pennsylvania  in  an  article  in  the  New  York 
Times,  April  13,  1913,  the  efforts  now  being  made  to  protect 
the  physical  health  of  children  are  really  increasing  the  num- 
ber of  hypochondriacs.     He  says: 

"We  are  doing  rather  too  much  in  protecting  the  physical 
health  of  children.  Many  of  them  are  being  so  imbued  with 
the  fear  of  disease  that  the  number  of  hypochondriacs  will  as- 


71 

suredly  be  increased,  and  hypochondriasis  is  a  form  of  mental 
disease." 

An  editorial  in  the  New  York  Medical  Journal  for  January 
31,  1920,  shows  how  medical  examinations  are  helping  to 
swell  the  rapidly  increasing  number  of  neurotics.     It  says: 

"A  good  many  of  the  illnesses  for  which  patients  seek  relief 
have  a  neurosis  as  their  basis  of  origin,  and  the  right  abdom- 
inal pain,  the  visual  disturbance,  or  the  headache  are  merely 
pegs  on  which  to  hang  unconscious  malingering.  Too  fre- 
quently the  peg  is  supplied  by  the  too  zealous,  but  not  over- 
careful,  physician  who,  by  his  acts  or  utterances,  implants  the 
idea  that  a  certain  physical  ailment  exists,  and  immediately  it 
is  created  mentally  by  the  patient.  *  *  *  Is  it  not  quite  as 
harmful  to  plant  erroneous  mental  suggestions  in  the  making 
of  an  examination?  If  we  are  helping  to  swell  the  rapidly 
increasing  number  of  neurotics,  is  it  not  our  duty  to  observe 
a  few  of  the  simple  precautions  which  will  put  a  stop  to 
this?" 

The  following  editorial  entitled  "The  Dread  of  Disease" 
which  appeared  in  "The  Youth's  Companion"  June  11,  1914, 
p.  310,  takes  the  position  that  a  compulsory,  universal  medical 
examination  would  probably  result  in  widespread  depression 
and  despair.     It  says: 

"Dr.  Goldwater,  the  New  York  Commissioner  of  Health, 
has  recently  published  an  article  advocating  'the  inauguration 
of  universal  periodic  medical  examinations  as  an  indispensable 
means  for  the  control  of  all  diseases.'  As  an  illustration  of 
the  need  and  importance  of  such  a  measure,  he  cites  the  re- 
cent examination  of  the  employes  of  a  New  York  bank.  Every 
one  of  them  was  found  'abnormal'  and  'on  the  sure  road  to 
diseases  of  heart,  lungs,  kidneys  or  blood  vessels.* 

"Possibly  that  discovery  may  have  been  useful  and  benefi- 
cial to  a  few  of  the  men,  that  it  was  so  to  all  may  reasonably 
be  doubted.  It  may  have  enabled  some  of  them  to  ward  off 
the  diseases  that  threatened.  In  the  cases  of  others,  however, 
impaired  health  must  have  been  owing  to  the  conditions  of 


73 

life  and  work,  conditions  beyond  the  individual's  control  or 
power  to  remedy.  To  tell  such  a  person  about  the  damaging 
but  unsuspected  processes  going  on  within  him  is  to  do  him 
no  kindness.  His  latent  malady  is  far  less  likely  to  be  pro- 
gressive while  he  is  unaware  of  it;  ignorance  acts  as  a  stay 
of  execution. 

"The  danger  of  such  universal  medical  examination  as  the 
health  commissioner  pleads  for  is  that  it  would  transform 
innumerable  happy  and  to  all  intents  and  purposes  healthy 
persons  into  melancholy  watchers  of  their  own  symptoms,  who 
would  never  again  dare  to  exert  them.selves  hopefully  and 
eagerly  in  the  business  of  life.  So  far  from  prolonging  life, 
imparting  such  dire  knowledge  of  themselves  to  people  would 
be  the  means  of  shortening  their  term  and  of  limiting  their 
happiness  and  their  usefulness. 

"A  healthy  mental  attitude  is  the  greatest  of  all  helps  in  pre- 
serving physical  sanity ;  break  down  a  healthy  mental  attitude, 
and  the  baleful  germs  that  are  in  all  of  us  will  riot  uncon- 
trolled. If  all  the  employes  of  a  bank  are,  according  to  the 
medical  examiner,  pathological  cases,  what  number  of  the 
employes  of  a  factory  or  a  department  store  would  be  pro- 
nounced entirely  sound?  Virtually  all  of  us  go  through  life 
with  engines  that  are  more  or  less  imperfect,  but  that  do  their 
work  satisfactorily  enough  as  long  as  we  do  not  watch  them, 
tinker  over  them  and  fuss  with  them.  A  compulsory,  univer- 
sal medical  examination  would  probably  result  in  wide- 
spread depression  and  despair." 

Children's  Bureau  Campaign  a  Failure. — In  1918  the 
Children's  Bureau  of  the  United  States  Department  of  Labor 
carried  on  a  gigantic  campaign  for  the  medical  examination 
of  children  of  pre-school  age. 

Referring  to  the  campaign  that  was  conducted  by  the  Chil- 
dren's Bureau,  Dr.  Grace  L.  Meigs  in  the  Journal  of  the 
American  Medical  Association  for  July  27,  1918,  stated  that 
the  Children's  Bureau  had  enlisted  the  help  of  the  many  mil- 


73 

lions  of  women  represented  by  the  Woman's  Committee  of  the 
Council  of  National  Defense.  In  almost  every  county  in  this 
country  a  committee  was  formed.  DV.  Meigs  refers  to  five 
million  families  and  many  thousands  of  communities  as  hav- 
ing taken  part.  The  alleged  purpose  of  the  campaign  of  the 
Children's  Bureau  was  to  save  100,000  lives.  Statistics  fail 
to  show  that  any  lives  whatever  were  saved  by  means  of  the 
campaign.  On  the  other  hand,  the  number  of  deaths  of  chil- 
dren under  five  years  of  age  in  the  registration  area  in  1917 
was  243,708  and  in  1918  it  v/as  306,143  or  an  increase  in  the 
number  of  deaths  in  1918  over  that  of  1917  of  62,435. 

Rural  Districts,  Without  Medical  Inspection,  Etc.  Health- 
ier Than  Cities. — In  the  propaganda  for  medical  examina- 
tion of  school  children  in  rural  districts  as  well  as  cities  the 
statement  has  quite  frequently  been  made  that  the  children 
in  the  cities  were  healthier  because  medical  examination  of 
school  children  is  more  prevalent  in  the  cities.  Both  the  cen- 
sus figures  and  the  first  and  second  reports  of  the  Provost 
Marshal-General  on  the  operations  of  the  draft,  however,  give 
statistics  showing  the  better  physical  condition  of  persons 
living  in  the  rural  regions  as  compared  to  the  urban  regions. 

According  to  Mortality  Statistics,  1916,  Bureau  of  the  Cen- 
sus, the  death  rate  for  1916  was  14  per  thousand  in  the  regis- 
tration area.  In  the  rural  part  of  the  registration  states  the 
death  rate  was  12.9  while  the  cities  in  the  registration  area 
had  a  death  rate  of  15,  and  in  the  registration  cities  in  non- 
registration states  the  death  rate  was  15.3,  which  gives  a  much 
better  showing  for  the  rural  population  as  compared  to  the 
city  population. 

The  follov/ing  is  from  the  Report  of  the  Provost  Marshal- 
General  to  the  Secretary  of  War  on  the  First  Draft  under  the 
Selective  Service  Act,  1917,  p.  47 : 

"As  between  urban  and  rural  residents,  the  figures  throw 
an  interesting  light  on  the  much  discussed  question  of  the 
relative  physical  condition  of  country  and  city  boys.     Selec- 


74 

tion  was  made  of  a  typical  set  of  cities  of  40,000  to  500,000 
population  having  no  large  element  of  foreign  immigrants  and 
distributed  over  ten  different  states  (Alabama,  Arkansas,  Cali- 
fornia, Colorado,  Kansas,  Montana,  Nebraska,  New  York, 
North  Carolina  and  Texas)  and  a  corresponding  set  of  coun- 
ties of  similar  total  size  located  in  the  same  states,  and  con- 
taining no  city  of  30,000  population,  the  total  number  of 
registrants  represented  was  315,000.  The  comparison  results 
as  follows: 

Table  16 

Per  cent  of 
examined 
Urban  and  rural  rejections  No.  rejected 

(1)     Urban  areas,  total  persons 

physically  examined  35,017 

(8)     Accepted  35,048  71.53 

(3)  Rejected  9,969  28.47 

(4)  Rural  areas,  total  persons 

physically  examined  44,463 

(5)  Accepted  - 32,030  72.04 

re)     Rejected  12,432  27.96 

A  similar  finding  was  reached  as  the  result  of  investigations 
carried  on  in  connection  with  the  second  draft.  The  follow- 
ing is  from  the  Second  Report  of  the  Provost  Marshal-Gen- 
eral to  the  Secretary  of  War  on  the  Operations  of  the  Selec- 
tive Service  System  to  December  20,  1918,  p.  159 : 

"Urban  and  rural  physical  rejections  compared.  Table  52 
contrasts  rejections  in  certain  urban  and  rural  communities. 
Urban  communities  were  selected  from  boards  in  the  cities 
of  New  York,  Chicago,  Philadelphia,  Cleveland,  Milwaukee, 
Seattle,  St.  Louis,  Cincinnati  and  New  Orleans.  Rural  com- 
munities were  taken  from  all  states,  using  only  boards  having 
les$  than  1,300  registrants  in  the  June  5,  1917,  registration. 
The  results  are  as  follows: 


75 

"Table  52 — Rural  and  urban  physical  rejections  compared. 

Per  cent  of 
No.  examined 

1.  Total  examined  in  100  selected 

urban  and  rural  regions 200,000 

2.  Rejected  in  100  selected  urban 

and  rural  regions  38,569             19.28 

3.  Examined  in  urban  regions 100,000 

4.  Rejected  in  urban  regions 21,675             21.68 

5.  Examined  in  rural  regions 100,000 

6.  Rejected  in  rural  regions 16,894            16.89 

"For  further  study,  Appendix  Table  51-A  gives  a  percent- 
age comparison  of  rejections  by  disqualifying  defects,  for 
eight  urban  and  eight  rural  districts.  In  this  table  45,000 
rejects  were  studied,  nearly  equally  divided  between  city  and 
country, 

"The  figures  of  both  of  these  studies  indicate  that  a  con- 
siderable physical  advantage  accrues  to  the  boy  reared  in  the 
country." 

Medical  Examinations  Of  Children  A  Step  Toward  Com- 
pulsory Medical  Treatment. — The  next  step  after  securing 
medical  examination  of  school  children  in  a  municipality  is 
to  ask  for  school  clinics,  and  the  next  step  after  that  would 
be  to  ask  for  compulsory  medical  treatment. 

In  an  article  in  the  Boston  Medical  and  Surgical  Journal 
for  April  25,  1912,  Dr,  Richard  C.  Cabot  said: 

"We  now  send  children  for  treatment  to  the  family  phy- 
sician, or  to  hospitals.  The  family  physician  will  never  be 
expert  enough  to  know  what  adenoids  are  to  be  taken  out  and 
what  left  in.  I  don't  believe  that  the  family  physician  will 
ever  be  expert  enough  to  recognize  incipient  tuberculosis  or 
to  know  which  cardiac  murmurs  mean  heart  disease  and  which 
do  not.  I  have  not  the  least  idea  that  one  of  every  forty-two 
children  has  heart  disease,  as  the  recent  examinations  of  school 
children  seem  to  show.     I  think  the  inspectors  have  done  the 


76 

best  they  could,  but  I  doubt  if  so  many  children  are  really 
suffering  from  heart  disease,  and  this  illustrates  what  I  mean 
when  I  say  that  it  is  impossible  for  practitioners  not  espe- 
cially trained  in  those  things  to  recognize  and  treat  the  de- 
fects of  school  children  effectively. 

"If,  on  the  other  hand,  the  children  have  to  be  carried  back 
and  forth  to  the  hospital,  their  condition  cannot  be  observed 
minutely  from  day  to  day,  as  it  could  were  clinics  attached 
to  the  school.  In  the  schools  the  children  have  to  be  present 
every  day  and  so  their  condition  could  be  checked  up  fre- 
quently in  the  clinics.  Or  if  they  are  not  there,  but  kept  home 
by  illness,  the  nurse  can  see  them  frequently  in  their  homes 
and  report  to  the  school  clinic  doctor. 

"The  central  point  in  all  these  defects  seems  to  me  this, — 
that  if  you  mean  business,  if  you  really  mean  to  put  so  much 
time  and  money  into  these  things,  if  the  state  is  ready  to  pay 
physicians  to  diagnose  diseases,  then  it  ought  to  follow  up 
diagnosis  by  treatment.  Otherwise  the  money  and  bother 
spent  on  getting  the  diagnosis  is  largely  wasted.  Only  in 
school  clinics  will  treatment  ever  be  effective." 

The  intolerant  attitude  assumed  by  leading  proponents  of 
medical  examination  of  school  children  is  illustrated  by  the 
following  extracts  from  an  editorial  in  the  Journal  of  the 
American  Medical  Association  for  May  22,  1920,  p.  1460,  re- 
garding the  death  from  diphtheria  of  a  child  who  died  without 
having  had  medical  attention  but  who  received  other  treat- 
ment: 

"The  efficacy  of  the  modern  scientific  medical  treatment  of 
diphtheria  is  not  a  matter  of  theory,  belief  or  conscience — it 
is  a  matter  of  fact.  Its  efficacy  is  as  demonstrable  as  is  the 
efficacy  of  the  Westinghouse  air  brake.  The  parent  or 
guardian  who  fails  to  give  his  child  or  ward  the  benefit  of 
modern  medical  treatment  for  diphtheria  becomes  as  culpable 
as  a  railroad  would  be  if  it  failed  to  equip  its  passenger  trains 
with  air  brakes.     Sometimes,  it  is  true,  the  air  brake  fails  to 


77 

avert  a  fatality ;  but  that  is  not  the  fault  of  the  air  brake,  nor 
is  it  any  argument  for  its  abolition. 

"If  an  adult  in  his  own  right  mind  wishes  to  be  treated 
by  *  *  *  or  any  other  unscientific  methods,  there  can  be 
no  objection,  provided  the  disease  from  which  he  is  suffering 
may  not,  through  such  treatment,  become  a  menace  to  the 
community.  Children  of  tender  years,  however,  should  not 
be  sacrificed  to  the  distorted  views  of  those  who  are  supposed 
to  be  their  protectors." 

Compulsory  medical  treatment  is  unjustified  for  the  same 
reasons  that  a  medical  monopoly  through  medical  practice 
acts  as  discussed  under  Chapter  VI  is  unjustified.  It  is  also 
contrary  to  the  fundamentals  of  American  government  as 
expressed  in  the  constitution  and  in  the  Declaration  of  In- 
dependence. 

Metropolitan  Daily  Doubts  If  Universal  Medical  Exam- 
inations Are  Worth  the  Price. — Referring  to  a  recent  pro- 
posal by  D'r.  S.  S,  Goldwater,  former  Commissioner  of  Health 
of  New  York  City,  for  an  annual  medical  examination  of 
everybody  in  the  City  of  New  York,  which  would  include 
children  in  the  public  schools,  the  New  York  Evening  Post, 
in  an  editorial  May  11,  1914,  said: 

"It  is  by  no  means  on  the  score  of  legal  compulsion  alone 
that  the  proposal  of  'universal  periodic  medical  examination' 
is  open  to  objection.  Whether  brought  about  by  legal  re- 
quirement or  by  the  pressure  of  general  opinion,  the  benefits 
to  health,  and  the  prolongation  of  life,  which  it  might  bring 
about  would  be  purchased  at  a  tremendous  price.  What  that 
price  would  be  it  requires  some  pov/er  of  imagination,  perhaps, 
to  realize,  but  some  idea  of  it  may  be  obtained  from  the  very 
facts  which  Dr.  Goldwater  adduces.  Take  but  a  single  one 
of  them.  'In  a  recent  examination  of  the  employes  of  a  New 
York  City  bank,'  he  says,  '100  per  cent  of  the  employes  were 
found  to  be  abnormal  and  on  the  sure  road  to  diseases  of 
heart,  lungs,  kidneys,  or  blood  vessels.'  Very  likely  this  ex- 
amination will  have  been  the  means  of  stopping  the  progress 


78 

of  disease  in  the  case  of  some  of  these  men ;  but  if  the  fact  is 

as  stated,  the  whole  body  of  them  were  suddenly  converted 
from  a  group  of  normal  men,  nearly  all  of  whom  were  doubt- 
less going  about  their  work  and  their  play  with  no  thought 
of  sickness,  into  a  solid  body  of  semi-invaUds.  Who  shall 
say  that  the  addition  of  two  or  three  years  to  the  average 
duration  of  their  existence  will  outweigh,  in  the  scales  which 
measure  real  human  values,  the  freedom,  the  elasticity,  the 
unconsciousness  of  the  trammels  of  the  body,  which  have  been 
impaired  or  destroyed  by  this  intrusion? 

"And  even  from  the  standpoint  of  medical  results,  in  the 
narrowest  sense,  there  is  room  for  grave  misgivings.  Not  all 
diagnoses  are  correct;  not  all  alarms  given  by  medical  men 
are  w^ell-founded.  It  may  be  said  in  reply  that  we  must  do 
the  best  we  can.  So  be  it.  Let  ever}^  man  who  feels  that 
he  has  some  reason  to  suspect  that  there  may  be  something 
wrong  get  medical  advice  by  all  means,  and  get  it  early.  He 
must  take  his  chance  of  a  certain  average  percentage  of  error. 
But  w^hatever  that  percentage  of  error  may  now  be — and  it  is 
not  insignificant — would  be  a  mere  trifle  in  comparison  with 
what  the  new  programme  bids  fair  to  furnish.  'The  task  be- 
fore us,'  says  Dr.  Goldwater,  'is  to  discover  the  first  sign  of 
departure  from  the  normal  physiological  path,  and  promptly 
and  effectually  to  apply  the  brake.'  With  this  as  the  ideal 
before  them,  wnll  not  the  false  alarms  of  the  physicians  out- 
number those  of  today  ten  to  one,  or  fifty  to  one?  Will  not 
thousands  of  persons  who  might  have  lived  happily  and  com- 
fortably to  three  score  and  ten  before  that  'first  sign  of  de- 
parture' had  developed  into  anything  serious,  be  called  upon 
to  exercise  care,  to  be  solicitous  about  their  bodies  instead  of 
ignoring  them,  and,  in  no  one  knows  how  many  cases,  have 
their  lives  not  only  dulled,  but  actually  shortened  by  hypo- 
chondria ? 

"  'Those  to  whom  the  care  of  delicate  mechanical  apparatus 
is  entrusted,'  says  Dr.  Goldwater,  'do  not  wait  until  a  break- 
down occurs,  but  inspect  and  examine  the  apparatus  minutely, 


79 

at  regular  intervals,  and  thus  detect  the  first  signs  of  damage." 
This  is  the  favorite  simile  of  the  health-enthusiasts.  But  in  it 
are  imbedded  two  fatal  fallacies.  In  the  first  place,  the  work- 
ing of  a  machine  is  not  affected  by  our  concern  over  it, 
while  our  body  may  be.  And  secondly,  the  only  interest  we 
have  in  the  machine  is  that  it  shall  function  well  as  a  mechan- 
ism; while  in  the  case  of  our  bodies  we  may  deliberately 
choose  to  sacrifice  perfection  of  the  mechanism  to  other  ob- 
jects which  we  prize  more  highly — indeed,  \ve  must  do  so,  at 
some  point  or  other,  if  we  wish  to  keep  out  of  Bedlam." 

Numerous  other  large  newspapers  throughout  the  country, 
including  the  Brooklyn  (N.  Y.)  Eagle,  the  New  York  World, 
the  St.  Louis  Post-Dispatch,  the  St.  Louis  Republic  and  the 
Galveston  News  commented  adversely  on  the  proposal  by 
Dr.  Goldwater. 

University  Regent  Attacks  Medical  Examinations  As  Pa- 
ternalistic and  Unwarranted. — In  an  address  at  the  Con- 
vocation of  the  University  of  the  State  of  New  York,  October 
22-24,  1908,  William  Nottingham,  M.  A.,  Ph.  D.,  LL.  0.,  a 
Regent  of  the  University,  protested  against  the  medical  ex- 
amination and  treatment  of  children  in  the  public  schools. 
Speaking  on  the  subject,  "How  Far  Are  School  Authorities 
Justified  in  Assuming  Responsibility  for  the  Health  and  Phys- 
ical Condition  of  Pupils",  Dr.  Nottingham  said: 

"There  are  many  indications  that  we  are  drifting  toward  the 
pernicious  notion  that  the  citizen  is  the  ward  of  the  state. 
This  conception  is  not  only  unworthy  of  us  and  our  times, 
but  it  is  unjust  to  him  and  tends  to  lessen  his  self-dependence, 
impair  his  self-respect,  and  hamper  his  efforts  to  reach  his 
highest  destiny.  We  would  much  better  take  the  loftier  and 
more  healthful  view,  that  the  average  American,  by  birth, 
amid  our  institutions,  is  naturally  endowed  with  a  keen  sense 
of  his  personal  rights  and  privileges,  with  an  abounding  am- 
bition to  do  things  and  a  large  capability  of  looking  out  for 
himself.  We  are  ages  in  advance  of  the  Spartan  regime  under 
which  the  child  at  birth  was  examined  by  the  ruling  elders 


80 

to  determine  whether  or  not  he  was  fit  to  be  reared,  and  at 
the  age  of  seven  was  taken  over  by  the  state.     *     *     * 

"It  requires  but  a  casual  observation  on  the  part  of  the 
thinking  person  to  discover  a  distinct  drift  toward  paternalism 
in  the  governmental  administration  of  affairs  in  this  country. 

*  *  *  Never  more  than  under  our  system  has  everyone 
the  right  to  know  by  what  authority,  under  what  pretext,  and 
for  what  purpose,  does  the  state  propose  to  invade  the  pri- 
vate domain  of  the  citizen. 

"Converging  our  thoughts  then  directly  upon  the  subject 
in  hand :  When  it  is  suggested  that  the  'school  authorities 
assume  responsibility  for  the  health  and  physical  condition 
of  the  pupils'  an  important  question  at  once  arises.  We  must 
all  agree  that  such  responsibility  cannot  exist  without  the 
legal  right  and  incidental  powers  necessary  to  its  discharge. 

*  *  *  The  parents  naturally  would  like  to  know,  when 
they  send  their  child  off  to  school  in  the  morning,  how  much 
of  him  they  may  fairly  anticipate  will  return  at  night„  and 
by  what  authority  the  missing  parts  have  been  sub- 
tracted.    *     *     * 

"Again  assuming  that  it  were  legally  permissible,  would  it 
be  a  wise  policy  for  the  school  authorities  to  assume  respon- 
sibility for  the  health  and  physical  condition  of  pupils?  In 
this  country,  at  least  until  quite  recently,  it  has  been  generally 
believed  that  this  duty  rested  primarily  upon  the  parent,  and 
that  the  performance  of  this  office  for  the  child  was  pecu- 
liarly within  the  province  and  obligation  of  the  home.  But 
from  what  we  have  seen  of  late  in  the  public  prints  we  infer 
that  it  has  been  suddenly  discovered  that  the  legal  guardian 
has  been  remiss  in  his  duties  and  thel  necessity  revealed  of 
delegating  this  work  to  the  school.     *     *     * 

"Assuming,  however,  for  the  sake  of  the  argument,  that 
the  physical  condition  of  the  average  pupil  is  as  bad  as 
claimed,  does  that  afford  a  sufficient  reason  for  enlarging  the 
burdens  and  increasing  the  labors  of  those  in  charge  by  turn- 
ing the  schools  into  general  hospitals  or  free  dispensaries.'' 


81 

It  is  the  plain  duty  of  the  school  authorities  to  see  to  it  that 
the  school  buildings  and  all  places  where  the  students  assem- 
ble for  stud)''  are  safe,  sanitary,  comfortable,  well  lighted  and 
ventilated,  and  in  every  way  suitable  and  calculated  to  facili- 
tate and  promote  the  work  to  be  there  performed.  When  they 
assume  to  go  beyond  this,  and  to  take  charge  of  the  physical 
condition  and  health  of  the  pupil  we  beheve  they  have  trans- 
cended their  functions.  This  duty  should  be  left  to  the  parent 
or  legal  guardian,  where  it  properly  belongs. 

"Furthermore,  although  there  may  be  exceptional  cases 
and  localities,  we  should  say  as  a  general  rule  that  if  the 
duty  of  looking  after  the  health  and  physical  condition  of 
the  child  is  taken  from  the  parent  and  his  chosen  physician 
and  delegated  to  the  school,  it  is  not  likely  to  be  so  well 
performed.  Those  medical  practitioners  who  are  appointed 
under  any  political  regime  to  the  charitable  work  of  the 
state  are  not  apt  to  be  the  most  experienced  or  skilled  phy- 
sicians or  surgeons,  but  rather  the  new  recruits  to  the  pro- 
fession who  are  looking  for  business.  Should  the  schools 
add  this  department  I  can  readily  discern  the  opening  up 
of  a  large  field  for  exploitation  and  experiment. 

"Finally,  in  the  nurture  and  training  of  youth  the  home 
and  the  school  have  their  distinct  and  peculiar  duties  and 
functions — ^both  exalted  and  important.  The  vital  and  essen- 
tial relation  of  each  to  the  progress  of  our  people  cannot  be 
too  strongly  emphasized.  The  home  should  not  be  encour- 
aged to  think  that  it  can  shoulder  its  obligations  upon  the 
school.  The  school  must  supplement  the  home,  but  never 
supplant  it" 


CHAPTER  VIII. 

COMPULSORY  VACCINATION  IS  BASED  UPON 

SUPERSTITION,  COMMERCIALISM  AND 

PATERNALISM 


"In  many  cases  physicians  become  interested  in  the  strict  en- 
forcement of  the  law  because  of  the  fees  resulting  therefrom  *  *  * 
In  the  more  populous  districts  the  medical  fees  resulting  from  vac- 
cination are  an  important  item.  ...  It  is  not  claimed  that 
physicians  as  a  rule  are  governed  in  this  matter  by  a  mercenary 
motive.  *  *  *  However,  this  mercenary  motive  has  been  the 
controlling  factor  in  a  sufficient  number  of  cases  which  have  come 
to  the  attention  of  this  Department  to  justify  the  above  assertion." 
— From  Fifth  Annual  Report  by  Andrew  S.  Draper,  Commissioner 
of  Education,  New  York  State,  Albany,  January  25,  1909,  p.  11. 

"The  conclusion  is  in  every  case  the  same:  that  vaccination  is 
a  gigantic  delusion;  that  it  has  never  saved  a  single  life;  but  that 
it  has  been  the  cause  of  so  much  disease,  so  many  deaths,  such  a 
vast  amount  of  utterly  needless  and  altogether  undeserved  suffer- 
ing, that  it  v/ill  be  classed  by  the  coming  generation  among  the 
greatest  errors  of  an  ignorant  and  prejudiced  age,  and  its  penal 
enforcement  the  foulest  blot  on  the  generally  beneficent  course  of 
legislation  during  our  century." — Professor  Alfred  Russel  Wallace, 
in  "The  Wonderful  Century,"  1899,  p.  313. 

THE  practice  of  vaccinating  persons  against  smallpox  is 
the  outgrowth  of  smallpox  inoculation,  or  the  injection 
of  virus  taken  directly  from  a  smallpox  patient.  It  was  soon 
found,  however,  that  the  practice  of  smallpox  inoculation 
actually  spread  the  disease  and  was  condemned  by  act  of  Par- 
liament as  a  criminal  offense  in  1840. 

When  referring  to  the  early  history  of  vaccination  it  is 
customary  for  advocates  of  compulsory  vaccination  to  refer 
to  Dr.  Edward  Jenner  as  the  discoverer  of  vaccination  in  1798. 
In  medical  writings  reference  is  occasionally  made  to  small- 
pox inoculation  but  in  public  little  or  nothing  is  said  about 


83 

the  period  preceding  Jenner  when  smallpox  inoculation  was 
practiced  extensively. 

These  facts  in  regard  to  the  period  preceding  smallpox 
vaccination  are  brought  out  in  the  Dissenting  Report  of  the 
late  Mr.  John  Pitcairn,  member  of  the  Pennsylvania  State 
Vaccination  Commission,  authorized  by  joint  resolution  of 
the  General  Assembly,  of  June  14,  1911,  and  issued  in  1913. 
It  also  refers  to  the  varying  claims  made  for  vaccination.  It 
says: 

P.  10.  "The  direct  progenitor  of  vaccination  was  small- 
pox inoculation — the  insertion  of  the  running  matter  from 
the  sore  of  a  smallpox  patient  into  the  blood  of  a  healthy 
person.  This  practice  was  introduced  into  England,  in  1731, 
by  Lady  Maiy  Wortley  Montagu,  wife  of  the  British  Am- 
bassador at  Constantinople.  Writing  from  that  city  Lady 
Montagu,  said  that  smallpox  was  rendered  entirely  harmless 
there  by  the  invention  of  what  the  Turks  called  'ingrafting,' 
and  that  there  was  a  set  of  old  women  who  made  it  their 
business  to  perform  the  operation. 

*     *     *     * 

"But  facts  could  not  long  be  ignored.  Instead  of  proving 
itself  a  harmless  and  beneficent  invention,  experience  made  it 
evident  that  the  practice  of  smallpox  inoculation  actually 
(and  naturally  enough)  spread  smallpox — every  inoculated 
person  becoming  a  new  center  of  contagion.  This  fact  so 
strongly  impressed  itself  on  the  British  public  that  in  1840 
the  inoculation  which  had  been  so  highly  endorsed  by  the 
Royal  College  of  Physicians  was  condemned  by  Act  of  Par- 
liament as  a  criminal  offense. 

"But  previous  to  this  time  a  new  'scientific'  protection 
against  smallpox  had  been  discovered.  This  discovery,  as 
is  well  known,  was  given  to  the  world  in  1798,  by  Edward 
Jenner,  popularly  called  the  Father  of  Vaccination.  It  is 
not  so>  well  known,  however,  that  the  vaccination  advocated 
by  Jenner  has,  like  smallpox  inoculation,  been  long  since  re- 
pudiated by  the  medical  profession.    Jenner's  first  experi- 


84 

ment  was  with  swinepox,  with  which  he  inoculated  one  of 
his   ovm  children    (who   afterwards   died   of   tuberculosis). 

*    *     *    * 

P.  13.  "At  first  one  vaccination  was  to  protect  for  life; 
this  claim  was  soon  modified  and  two  vaccinations  were  con- 
sidered necessary  to  confer  lifelong  immunity.  The  obsti- 
nacy of  smallpox  in  attacking  persons  so  vaccinated  then  re- 
sulted in  shortening  the  period  of  immunity  to  fourteen  years; 
later  it  v/as  reduced  to  seven  years,  then  five,  and  in  the 
Spanish-American  War — as  shown  by  the  practice  of  our 
army  surgeons — six  weeks  was  considered  the  limit  of  im- 
munity." 

Smallpox  Reduction  Due  to  Sanitation. — Dr.  C.  Killick 
Millard,  Medical  Officer  of  Health  for  Leicester,  England, 
in  a  recent  book  entitled  "The  Vaccination  Question"  issued 
in  1914,  calls  attention  to  the  decline  in  smallpox  along  with 
such  other  diseases  as  the  plague,  cholera  or  typhus  fever 
due  to  sanitation.     He  says: 

P.  VHI,  Preface.  "For  forty  years,  corresponding 
roughly  with  the  advent  of  the  'sanitary  era',  smallpox  has 
gradually  but  steadily  been  leaving  this  country  (England). 
For  the  past  ten  years  the  disease  has  ceased  to  have  any 
appreciable  effect  upon  our  mortality  statistics.  For  most 
of  that  period  it  has  been  entirely  absent  except  for  a  few 
isolated  outbreaks  here  and  there.  It  is  reasonable  to  believe 
that  with  the  perfecting  and  more  general  adoption  of  mod- 
ern methods  of  control  and  with  improved  sanitation  (using 
the  term  in  its  widest  sense)  smallpox  will  be  as  completely 
banished  from  this  country  as  has  been  the  case  with  plague, 
cholera,  or  typhus  fever.  Accompanying  this  decline  in  small- 
pox there  has  been  a  notable  diminution  during  the  past 
decade  in  the  amount  of  infantile  vaccination.  This  falling 
off  in  vaccination  is  steadily  increasing  and  is  becoming  very 
widespread.    *    *    * 

P.  22.    "It  cannot  be  denied  that  vaccination  causes,  in  the 


85 

aggregate,  very  considerable  injury  to  health,  most  of  it  only 
temporary,  but  some  permanent.  It  is  true  that  the  deaths 
certified  as  due  to  vaccination  are  less  numerous  now  than 
they  used  to  be,  but  some  deaths  still  occur  every  year. 
*  *  *  During  the  last  decade  the  deaths  from  vaccinia 
have  several  times  outnumbered  those  from  smallpox,  vv^hilst 
if  we  have  regard  to  the  amount  of  ill-health  caused  by  the 
two  diseases  (and  putting  aside  for  the  moment  the  question 
of  the  alleged  effect  of  vaccination  in  lessening  smallpox)  it 
looks  as  if  vaccinia  were  becoming,  so  far  as  the  community 
is  concerned,  the  more  serious  disease  of  the  two.    *    *     * 

P.  185.  "The  orthodox  view,  held  by  most  Medical  Offi- 
cers of  Health,  is  that  there  is  a  grave  danger  of  smallpox 
returning  in  widespread  epidemic  form  and  causing  a  terrible 
mortality  as  was  the  case  in  the  pre-vaccination  era.  *  *  * 
Undoubtedly,  many  have  a  genuine  fear  that  if  smallpox  once 
succeeded  in  obtaining  a  foothold  in  an  unvaccinated  com- 
munity it  would  spread  'with  a  rapidity  of  which  we  have 
in  recent  times  had  no  experience.'  I  realize  that  any  one 
who  suggests  that  this  view  is  unduly  alarmist  incurs  a  cer- 
tain measure  of  responsibility,  and  I  believe  that  this  reflec- 
tion has  hitherto  deterred  those  who  might  otherwise  have 
been  inclined  to  express  a  more  sanguine  view.  Personally, 
having  been  Medical  Officer  of  Health  for  thirteen  years  in 
a  town  which,  for  practical  purposes,  may  be  regarded  as 
unvaccinated;  living  and  moving,  as  I  do,  amongst  a  child 
population  90  per  cent  of  which  is  unvaccinated,  I  feel  un- 
able to  subscribe  to  this  pessimistic  view.  I  believe  that  the 
sanitary  condition  of  the  country  has  been  so  greatly  im- 
proved, and  alternative  measures  for  dealing  with  smallpox 
have  been  so  highly  evolved,  that  we  shall  never  revert  to 
the  stage  of  things  which  existed  in  the  days  before  vaccina- 
tion was  discovered." 

Statistics  fail  to  show  that  the  mildness  of  smallpox  in  the 
United  States  and  the  small  number  of  deaths  caused  by  small- 
pox are  due  to  vaccination,  according  to  Assistant  Surgeon 


General  John  W.  Trask  of  the  United  States  Public  Health 

Service.    He  says*: 

"One  of  the  most  notable  features  of  the  smallpox  which 

has  been  more  or  less  prevalent  in  the  United  States  for  at 

least  ten  years  is  its  extreme  mildness  and  the  small  number 

of  deaths  which  it  has  caused.  In  1909  the  combined  states 

from  which  complete  reports  were  received  had  19,534  cases 

with  92  deaths,  which  was  a  mortality  rate  of  0.471  for  each 

100   cases.     In   1910  the  rate  was  considerably  higher,  but 

still  remarkably  low  when  compared  with  the  rates  reported 

from  other  countries. 

*    *    *    * 

"That  the  community  is  protected  by  vaccination  may  be 
true  for  certain  localities,  but  that  the  protection  thus  afforded 
is  general  can  hardly  be  maintained.  Japan  as  a  nation  is 
probably  as  well  or  better  protected  by  vaccination  than  is  the 
United  States,  and  yet  in  1907-1908  there  was  an  outbreak  of 
smallpox  in  Japan  in  which  19,101  cases  were  reported  with 
6,273  deaths.  Vaccination  did  not  there  modify  the  type  of 
the  disease  to  that  found  in  America.  In  that  outbreak  among 
5,215  smallpox  patients  1,527  were  found  who  had  never  been 
vaccinated.  This  is  interesting  as  indicating  a  relatively  small 
number  of  unvaccinated  individuals.  The  epidemic  was  ap- 
parently one  of  considerable  virulence,  the  general  death  rate 
per  100  being  42.25  among  the  cases  in  1907  and  32.32  among 
those  in  1908,  while  the  deaths  among  the  unvaccinated  were 
69.4  per  100  cases.  Kitasato  believes  that  the  virulence  of  the 
disease  varies  and  that  when  it  reaches  the  high  point  attained 
in  Japan  during  1907-1908  individuals  who  have  been  previ- 
ously vaccinated,  and  even  those  who  have  previously  had  an 
attack,  contract  the  disease.  In  this  outbreak  there  were  242 
cases  in  seven  prefectures  in  which  the  patient  had  previously 
had  the  disease.    Of  these,  57  died. 

^Extracts  from  "Smallpox  in  the  United  States — Prevalence  and  Geographic 
Distribution  During  tha  Calendar  Year  1910,"  by  John  W.  Trask,  Assistant 
Surgeon  General  of  the  United  States  Public  Health  Service  in  "Public  Health 
Reports,"  official  weekly  publication  of  the  United  States  Public  Health  Service, 
June   23,    1911,   pp.   944-945. 


87 

"If  the  non- virulence  of  the  disease  in  this  country  is  due 
to  protection  by  vaccination  it  would  be  expected  that  the  mild 
cases  would  be  found  only  in  those  so  protected.  This  may 
be  assumed  from  the  limited  information  available  not  to  be 
the  case.  Records  of  the  vaccination  history  of  all  patients 
would  undoubtedly  add  much  to  our  knowledge  of  the  sub- 
ject. 

"That  the  type  of  the  disease  as  seen  in  the  United  States 
is  due  to  the  protective  value  of  vaccination  is  sho>vn  not  to 
be  true  for  certain  localities  in  which  outbreaks  of  the  viru- 
lent form  of  the  disease  have  been  reported.  These  outbreaks 
have  occurred  at  widely  separated  points  extending  from  Vir- 
ginia and  South  Carolina  in  1909  to  Michigan,  Oklahoma, 
Texas  and  Oregon  in  1910.     *     *     *  " 

Vaccination  a  Surgical  Procedure,  Sometimes  Followed 
by  Severe  and  Even  Fatal  Results. — The  following  are  a 
few  out  of  a  large  number  of  admissions  by  advocates  of  vac- 
cination that  severe  and  even  fatal  results  may  follow  the 
use  of  vaccine  virus. 

Vr.  Milton  J.  Rosenau,  Professor  of  Preventive  Medicine 
and  Hygiene  in  Harvard  University,  says^ : 

"However,  vaccination  is  not  always  a  harmless  procedure ; 
it  must  be  looked  upon  as  the  production  of  an  acute  infec- 
tious disease,  and,  although  the  disease  is  always  mild  and 
trivial,  it  must  not  be  treated  as  trifling.  The  chief  danger 
lies  in  the  fact  that  we  have  produced  an  open  wound,  which 
is  subject  to  the  complications  of  any  wound.  Even  a  pin 
prick  or  a  razor  scratch  may  result  in  death.  While  the  ag- 
gregate number  of  deaths  resulting  from  the  complications  of 
vaccination  may  be  considerable,  the  aggregate  of  the  indi- 
vidual risk  is  so  small  as  to  be  disregarded,  especially  when 
proper  precautions  are  taken." 

The  New  York  Medical  Journal  in  an  editorial  July  17, 
1915,  said: 


^''Preventive  Medicine  and  Hygiene,"  by  Dr.  Rosenau,  published  by  D.  Apple 
ton   &   Co.  in    1914.  p,    19. 


88 

"The  next  step,  after  cleansing  the  patient,  was  the  investi- 
gation of  the  virus.  It  was  found  that  bacteria  of  many  sorts 
were  present  constantly.  The  attempt  was  then  made  to  de- 
crease the  number  and  experiments  showed  that  mixing  the 
virus  with  concentrated  glycerine  and  keeping  it  in  the  re- 
frigerator for  two  or  three  months  caused  a  great  reduction. 
The  spores  that  might  be  present,  however,  were  not  affected, 
while  the  activity  of  the  virus  was  impaired  considerably 
This  method  of  preparation,  nevertheless,  is  what  is  com- 
monly employed  today;  infections  are  not  numerous,  but  the 
percentage  of  'takes'  may  not  be  as  great." 

In  a  later  editorial,  December  11,  1915,  the  New  York 
Medical  Journal  said: 

"Tragic  events,  especially  if  preventable  in  any  degree, 
which  jeopardize  a  procedure  of  such  vast  importance,  should 
receive  most  earnest  attention. 

"Tetanus  following  vaccination  is  an  event  of  just  this  char- 
acter. All  available  evidence,  both  clinical  and  experimental, 
justifies  the  belief  that  infections  of  this  kind  are  not  due  to 
the  vaccine  virus  per  se,  but  occur  subsequently,  and  are  at- 
tributable to  later  contaminations  of  the  vaccination  wound. 
In  ail  justice,  however,  it  must  be  admitted  that  experience 
also  teaches,  despite  all  contrary  evidence,  that  vaccination 
wounds,  at  least  in  children  of  certain  ages,  are  unduly  prone 
to  such  infections.     The  reasons  are  not  apparent. 

"At  least  two  valuable  points  may  be  suggested  for  all  to 
follow.  First,  however,  trivial  the  operation  of  vaccination 
may  seem,  we  should  always  remember  that  it  is  a  surgical 
procedure,  sometimes  followed  by  severe  and  even  fatal  re- 
sults. It  should  therefore  be  done  with  all  possible  care, 
cleanliness,  and  attention.  Second,  if  tetanus  unfortunately 
develops,  it  should  not  be  forgotten  that  the  prompt  adminis- 
tration of  tetanus  antitoxin,  in  sufficient  quantity,  and  by  the 
proper  routes  may  result  in  saving  a  life." 

Compulsory  Vaccination  Fostered  by  Commercialism. — 
The  following  extracts  from  a  book  by  Mr.  Chas.  M.  Higgins 


89 

throws  an  interesting  light  on  the  extensive  commercialism 
back  of  compulsory  vaccination.     Mr.  Higgins  says^: 

"The  latest  official  reports  show  that  there  are  now  ninety- 
nine  concerns  licensed  by  the  U.  S.  Government  to  manufac- 
ture vaccines  and  serums  for  both  human  and  animal  uses! 
These  ninety-nine  concerns  have  a  capitalization  of  about  fifty 
millions  or  more.  One  of  the  largest  of  these  manufacturers, 
located  in  Detroit,  has  a  capital  of  ten  millions,  while  another 
large  concern  located  in  Philadelphia  has  a  capital  of  two 
millions. 

"The  two  great  epidemics  of  Foot  and  Mouth  Disease,  or 
virulent  cowpox,  in  this  country  in  1902  and  1908  were  caused 
by  the  vaccine  virus  of  two  of  these  ninety-nine  vaccine  manu- 
facturers; and  these  epidemics  resulted  in  great  mortality  to 
animals  and  mankind,  as  already  shown,  with  a  loss  of  mil- 
lions of  dollars  to  the  Government  and  people  of  the  United 
States ;  but  no  recompense  has  ever  yet  been  made,  so  far  as 
I  know,  to  the  Government  or  people  by  these  vaccine  com- 
panies for  this  great  damage,  and  I  ask  your  particular  at- 
tention, Mr.  President,  to  this  important  point. 

"Now,  to  give  a  list  of  all  the  medical  societies  in  the  United 
States  and  their  membership  figures  would  take  too  much 
space  here,  as  their  names  and  numbers  are  'legion' ;  but  I  can 
give  some  figures  which  will  include  the  chief  National  So- 
ciety and  the  chief  State  societies  in  the  leading  State  of  New 
York  as  follows : 

Members 

American  Medical  Association  43,000 

Medical  Society,  State  of  N.  Y 8,000 

Associated  Physicians  of  Long  Island 503 

Brooklyn  Medical  Association  300 

Medical  Society  of  Kings  County 950 

Harlem  Medical  Association  400 


^Horrors  of  Vaccination  Exposed  and  Illustrated — Petition  to  the  President  to 
Abolish  Compulsory  Vaccination  in  the  Army  and  Navy,"  by  Cbas.  M.  Higgins, 
Brooklyn,  N.  Y.      1920y 


90 

Members 

Medical  Association,  Greater  City  of  N,  Y 750 

Medical  Society  of  County  of  N.  Y ^...  3,709 

N.  Y.  Academy  of  Medicine 1,400 

"This  table,  while  including  only  a  partial  list  of  medical 

societies  in  the  United  States,  comprises  some  of  the  largest 
and  most  influential  societies  of  the  dominant  or  allopathic 
school,  active  in  the  national  field  and  in  our  own  local  field 
of  New  York  State.  Now  each  State  in  the  Union  has  a 
similar  group  of  local  or  State  Societies  and  these  several 
State  societies  combined  with  the  big  National  societies  and 
with  the  ninety-nine  vaccine  companies  form,  obviously,  a  most 
gigantic  medical,  political  and  commercial  interest  behind  the 
medical  evil  of  compulsory  vaccination.  Of  course,  a  great 
many  doctors  of  this  dominant  school  are  advanced  and  pro- 
gressive enough  to  oppose  all  compulsory  vaccination;  but 
doctors  of  this  type  unfortunately  seem  to  be  a  minority,  at 
present,  in  the  dominant  vaccine  school  of  medicine.  On  the 
other  hand,  a  large  majority  in  almost  all  of  the  other  schools 
of  medicine  are  strongly  opposed  to  vaccination,  particularly 
to  all  forms  of  compulsion. 

"A  glance  at  this  list  of  medical  societies  already  given, 
with  its  startling  membership  figures,  combined  with  the 
ninety-nine  vaccine  companies,  must  convince  any  thoughtful 
man  of  the  dangerous  size  and  organization  of  these  medical 
and  vaccine  interests,  which  obviously  have  more  or  less  of  a 
joint  interest  to  force  their  vaccine  operations  and  products 
upon  the  people  as  much  as  possible  by  compulsory  laws,  and 
otherwise,  and  whose  joint  profits  are  obviously  in  direct 
proportion  to  this  use. 

"Now,  no  other  profession  has  anything  like  the  large  and 
well  organized  membership  and  corresponding  political  power 
and  influence  of  the  medical  profession  in  the  body  politic. 
Indeed,  few,  if  any,  trade  or  business  organizations  can  com- 
c^are  with  the  medical  profession  in  this  respect,  and  this 


91 

medical  power  is  further  greatly  increased  beyond  that  of  any 
other  profession,  trade  or  business  in  being  in  practical  con- 
trol of  our  most  important  Departments  of  Public  Health 
and  Vital  Statistics  all  over  the  country,  so  that  in  advocating 
and  practicing  the  dangerous  barbarism  of  compulsory  medi- 
cine this  medical  power  can  easily  deny  and  conceal  the  actual 
effects  of  this  dangerous  medication  on  human  health  and  life 
in  our  vital  statistics.     *     *     * '» 

EXISTING  LAWS  AND  REGULATIONS 

Vaccination  against  smallpox,  typhoid  and  paratyphoid 
fever  are  compulsory  in  the  United  States  Army  and  Navy. 

The  United  States  quarantine  regulations,  1910,  provide 
that  persons  coming  from  localities  where  smallpox  is  pre- 
vailing, shall  not  be  allowed  entry  without  vaccination,  unless 
they  have  had  a  previous  attack  of  the  disease  or  have  been 
vaccinated  recently. 

The  laws  in  regard  to  compulsory  vaccination  are  being 
repealed  or  changed  in  so  many  states  that  a  digest  of  the 
laws  now  in  force  would  be  unrehable  a  few  months  hence. 

The  laws  now  in  force  range  all  the  way  from  providing 
for  compulsory  general  vaccination,  in  certain  cases,  to  mak- 
ing compulsory  vaccination  unlawful.  Some  states  provide 
that  the  state  board  of  health  may  require  vaccination  in  time 
of  epidemic  if  it  is  thought  to  be  necessary ;  some  states  pro- 
vide that  local  health  authorities  may,  when  deemed  neces- 
sary, adopt  measures  for  general  vaccination.  Vaccination  or 
quarantine  of  exposed  persons  is  provided  for,  either  by  law 
or  regulation  in  a  number  of  states.  Several  states  make  vac- 
cination a  condition  to  admission  to  the  public  schools.  The 
Pennsylvania  law  includes  all  public,  private,  parochial,  Sun- 
day or  other  schools.  In  a  number  of  states  vaccination  of 
school  children  is  made  optional  with  local  authorities,  and 
laws  passed  in  a  few  states  provide  that  unvaccinated  chil- 
dren may  be  excluded  from  the  public  schools  for  a  specified 
period  during  epIdemicSa 


92 

Compulsory  Vaccination  Forbidden. — In  1907  the  follow- 
ing law  was  passed  by  the  State  of  Utah : 

"Hereafter  it  shall  be  unlawful  for  any  board  of  health, 
board  of  education  or  any  other  public  board,  acting  in  this 
state  under  police  regulations  or  otherwise,  to  compel  by  reso- 
lution, order,  or  proceedings  of  any  kind,  the  vaccination  of 
any  child,  or  person  of  any  age ;  or  making  vaccination  a  con- 
dition precedent  to  the  attendance  at  any  public  or  private 
school  in  the  state  of  Utah,  either  as  pupil  or  teacher." — 
Section  1113x26  of  the  Compiled  Laws,  1907,  of  the  state 
of  Utah. 

In  the  early  part  of  1919  an  Act  was  passed  in  North  Da- 
kota providing  that  "No  form  of  vaccination  or  inoculation 
shall  hereafter  be  made  a  condition  precedent,  in  this  state,  for 
the  admission  to  any  pubHc  or  private  school  or  college,  of 
any  person,  or  for  the  exercise  of  any  right,  the  performance 
of  any  duty,  or  the  enjoyment  of  any  privilege,  by  any  per- 
son." Compulsory  vaccination  is  either  illegal  in  a  number 
of  other  states  or  permitted  only  under  specified  conditions. 

In  an  analysis  of  the  laws  and  regulations  relating  to  vac- 
cination in  force  in  the  United  States,  J.  W.  Kerr,  Assistant 
Surgeon  General  of  the  United  States  Public  Health  Service, 
says : 

"As  to  the  practical  enforcement  of  the  existing  provisions, 
no  opinion  can  be  expressed.  Health  authorities  of  various 
states  admit  that,  owing  to  general  apathy  or  lack  of  funds, 
vaccination  is  seldom  systematically  enforced,  except  perhaps 
in  the  case  of  school  children." 

Why  North  Dakota  Abolished  Compulsory  Vaccination. 
— The  law  passed  in  North  Dakota  was  the  outcome  of  a 
Supreme  Court  Decision  in  that  state  a  short  time  previous 
in  the  case  of  Lawrence  F.  Rhea  vs.  Board  of  Education  of 
Devil's  Lake.  The  court  in  that  case  held  that  the  Board 
5f  Health  was  not  authorized  to  issue  an  order  denying  to 
children  the  right  to  attend  the  public  schools  except  upon 
condition  of  being  vaccinated  where  it  appears  that  there  is 


93 

no  prevailing  epidemic  of  smallpox  and  no  imminent  danger 
from  this  disease  reasonably  anticipated;  that  school  officers 
were  not  authorized  to  exclude  children  for  non-vaccination, 
in  the  absence  of  a  showing  of  danger  due  to  the  existence 
of  smallpox  in  the  community  or  reasonably  imminent ;  that 
children  were  not  to  be  excluded  from  schools  on  the  sole 
ground  of  non-vaccination. 

The  opinion  of  the  Supreme  Court  written  by  Justice  Bird- 
sell  was  to  the  effect  that  the  North  Dakota  Board  of  Health 
and  the  Board  of  Education  of  Devil's  Lake,  acting  under  a 
regulation  of  the  State  Board  of  Health,  had  exceeded  their 
authority  in  attempting  to  make  vaccination  a  requirement  for 
admission  to  the  public  schools.  It  held  that  the  board  of 
health  was  not  the  public  prosecutor.  That  "Even  the  public 
prosecutor  could  not  compel  vaccination." 

Justice  Robinson  also  agreed  with  the  opinion  of  the  court 
but  wrote  a  separate  opinion  of  his  own.  The  separate  opin- 
ion by  Justice  Robinson  is  a  strong  denunciation  of  compul- 
sory vaccination  and  special  attention  is  called  to  the  following 
extracts  from  his  opinion  in  the  case  of  Lawrence  F.  Rhea  vs. 
Board  of  Education  of  Devil's  Lake,  N.  D.,  September  Term, 
1918: 

"The  non-vaccination  of  children — is  it  a  cause  for  exclud- 
ing them  from  the  public  schools  in  a  state  where  smallpox 
does  not  prevail,  and  where  the  sickness  and  death  resulting 
from  vaccination  would  far  exceed  that  now  resulting  from 
smallpox — that  is  the  question.  We  must  consider  not  only 
the  statutes,  but  also  the  origin  and  nature  of  smallpox.  It 
is  a  disease  which  originates  in  filth,  the  crowding  of  people 
together,  the  lack  of  pure  air,  good  food  and  good  sanitary 
conditions.  It  prevails  and  becomes  epidemic  only  in  coun- 
tries where  the  population  is  dense  and  the  sanitary  conditions 
are  bad.  It  was  in  such  countries,  and  in  days  when  sanita- 
tion was  unknown,  that  the  doctrine  of  vaccination  was 
promulgated  and  adopted  as  a  religious  creed.  Gradually  it 
spread  to  other  countries  where  conditions  are  so  different 


94 

that  vaccination  is  justly  regarded  as  a  menace  and  a  curse. 
And  where,  as  it  appears,  the  primary  purpose  of  vaccination 
is  to  give  a  living  to  the  vaccinators.  In  this  great  northwest 
the  disease  has  never  prevailed  to  any  considerable  extent  and 
it  has  never  become  epidemic.  Hence,  were  vaccination  to 
become  general,  it  would  be  certain  to  cause  the  sickness  or 
death  of  a  thousand  children  where  one  child  now  sickens  and 
dies  from  smallpox.  Of  course  a  different  story  is  told  by 
the  class  that  reap  a  golden  harvest  from  vaccination  and  the 
diseases  caused  by  it.  Yet,  because  of  their  self-interest,  their 
doctrine  must  be  received  with  the  greatest  care  and  scrutiny. 
Every  person  of  common  sense  and  observation  must  know 
that  it  is  not  the  welfare  of  the  children  that  causes  the  vac- 
cinators to  preach  their  doctrines  and  to  incur  the  expense  of 
lobbying  for  vaccination  statutes. 

*     *     *    * 

"England,  with  its  dense  population  and  insanitary  condi- 
tions, was  the  first  country  to  adopt  compulsory  vaccination, 
but  there  it  has  been  denounced  and  abandoned.  In  the  city 
of  Leicester  vaccination  has  long  since  been  tabooed,  and 
there,  because  of  special  regard  for  cleanliness  and  good  sani- 
tation, the  people  fear  no  smallpox.  But  in  Prussia,  Ger- 
many, and  other  such  countries,  the  light  shineth  in  darkness 
and  the  darkness  comprehendeth  it  not. 

"In  the  book  of  Dr.  Peebles  on  vaccination  there  are 
statistics  to  the  effect  that  25,000  children  are  annually  slaugh- 
tered by  diseases  inoculated  into  the  system  by  compulsory 
vaccination.  It  is  shown  beyond  doubt  that  vaccination  is  not 
infrequently  the  cause  of  death,  syphilis,  cancer,  consumption, 
eczema,  leprosy  and  other  diseases.  It  is  shown  that  if  vac- 
cination has  any  tendency  to  prevent  an  attack  of  smallpox, 
the  remedy  is  worse  than  the  disease. 

"In  the  last  printed  circular  of  the  Board  of  Health  it  is 
said:  'Compulsory  vaccination  is  required  in  the  schools  of 
this  state  this  year  for  the  first  time  in  history.  The  com- 
pulsory vaccination  law  has  been  on  the  statute  books  for 


95 

several  years  and  it  has  never  been  enforced  because  of  a 
seeming  unpopularity  with  a  certain  class  of  persons.' 

"For  the  months  of  July,  August  and  September,  1917,  the 
circular  gives  the  number  of  persons  dying  from  disease,  thus: 

"Smallpox 1 

"Consumption 72 

"Typhoid 6 

"Diphtheria    18 

"And  so  it  appears  that  smallpox  is  the  least  dangerous  of 
the  infectious  diseases.  With  proper  care  no  person  dies  of 
smallpox  and  the  disease  gives  the  patient  and  his  descendants 
more  or  less  immunity  from  other  diseases.  *  *  *  Child 
vaccination  in  a  state  where  smallpox  does  not  prevail,  it  is  a 
barbarism  and  it  is  the  duty  of  the  child  growers  to  rebel 
against  it. 

4:       *       4c       4( 

"Fmally,  the  proper  safeguard  is  by  sanitation.  The 
chances  are  that  within  a  generation  vaccination  will  cease  to 
exist.  It  will  go  the  way  of  inoculation,  bleeding,  purging 
and  salivation.  The  vaccinators  must  learn  to  live  without 
sowing  the  seeds  of  death  and  disease." 


CHAPTER  IX 

FAILURE  OF  MEDICAL  CONTROL  WHERE  MOST 

COMPLETE  AN   INDICTMENT  OF  STATE 

MEDICINE 

"It  is  apparent  that  it  is  more  dangerous  to  be  a  soldier  in  peace- 
ful United  States  than  to  have  been  on  the  firing  line  in  France. 
From  the  statistics  so  far  available,  the  death  rate  in  the  military 
camps  is  higher  than  among  the  civil  population,  even  in  similar 
age  groups.  The  mortality  in  New  York  and  Chicago,  for  in- 
stance, shows  that  the  death  rate  in  the  Army  is  more  than  double 
that  of  the  civi]  population  of  the  same  age  group.  There  is  also 
the  possibilitv  that  when  allowances  are  made  for  the  fact  that 
defectives  have  been  eliminated  from  the  Army,  and  that  these 
poor  'risks'  swell  the  civil  death  list,  the  corrected  margin  will  be 
still  further  increased  in  favor  of  the  civil  population." — Dr.  Victor 
G.  Heiser  in  the  Journal  of  the  American  Medical  Association,  De- 
cember 7,  1918. 

THE  failure  of  so-called  "preventive  medicine"  measures 
in  the  past  to  offer  any  real  protection,  as  experienced 
in  our  Army  and  Navy  during  the  recent  world  war,  as  ex- 
perienced in  the  nationwide  campaign  against  tuberculosis  and 
in  the  drastic  measures  instituted  during  the  influenza  epi- 
demic in  1918,  should  serve  as  a  warning  against  the  estabhsh- 
ment  of  state  medicine;  and  emphasize  the  importance  of 
giving  greater  attention  to  sanitation  and  living  conditions  in 
public  health  work. 

EXPERIENCE  IN  THE  ARMY 

As  previously  stated  vaccination  against  smallpox,  typhoid 
and  paratyphoid  fever  is  compulsory  in  the  United  States 
Army  and  Navy. 

Reference  has  already  been  made  under  Chapter  VIII  to 
the  dangers  following  the  use  of  smallpox  virus  and  the  lack 


97' 

of  sound  proof  that  vaccination  offers  any  protection  what- 
ever against  smallpox. 

The  dangers  in  the  use  of  typhoid  vaccination  are  brought 
out  by  Dr.  D'avis  and  Dr.  Woodruff  in  the  following.  Dr.  D. 
J.  Davis  in  the  Journal  of  the  American  Medical  Association 
for  February  24,  1912,  said : 

"We  should  remember  that  any  substance  that  will,  in  a 
healthy  individual,  cause  headache,  nausea,  insomnia  and  an 
increase  of  temperature  of  two  or  sometimes  three  degrees, 
etc.,  as  the  typhoid  vaccine  may  do  in  the  doses  used,  must 
be  considered  a  powerful  toxin.  Consequently,  it  is  reason- 
able to  assume  that  certain  changes,  such  as  myocardial  de- 
generation, vascular  changes,  kidney  degenerations,  etc.,  might 
easily  result,  though  they  may  be  manifested  only  at  a  much 
later  period  of  life.  And  perhaps  the  consequences  might  be 
much  more  severe  should  the  vaccine  be  injected  into  an  indi- 
vidual who  was  at  the  time  suffering  from  renal,  cardiac  or 
other  lesions.  At  any  rate,  it  would  seem  inadvisable  to  use 
the  vaccine  previous  to  a  careful  physical  examination." 

The  following  extracts  are  taken  from  a  lengthy  article 
by  Lieut-Col.  Qias.  E.  Woodruff,  M.  D.  (U.  S.  A.  Retired), 
entitled  'Tuberculosis  Following  Typhoid  Fever",  which  ap- 
peared in  the  January,  1914,  number  of  American  Medicine: 

"Le  Tulle  tells  me  that  all  serums  and  vaccines  will  cause 
incipient  cases  to  get  rapidly  worse.  He  has  particularly  no- 
ticed this  in  giving  the  antitoxins  of  diphtheria  and  tetanus. 
*  *  *  (Monde  Medical,  December  5,  1912.)  Chante- 
messe,  of  Paris,  informs  me  that  he  has  seen  two  cases  of 
rapid  tuberculosis  develop  a  few  days  after  anti-typhoid  vac- 
cination, and  he  warns  particularly  against  using  it  where 
tuberculosis  is  suspected. 

:):         >|c         ^         :{< 

"In  respect  to  non-tubercular  diseases  made  worse  by  ty- 
phoid, Vincent  (ibid)  mentions  many  which  are  adversely 
affected  by  anti-typhoid  vaccine;  and  Spooner  (ibid)  says  that 
every  latent  or  chronic  non-typhoidal  disease  is  made  worse 


98 

by  it  and  though  there  was  prompt  recovery  as  a  rule  some 
'accidents'  occurred.  The  instructions  as  to  the  vaccine  em- 
phasize the  caution  not  to  use  it  if  there  is  any  sign  of  disease 
or  debility.  Prendergast  gave  the  vaccine  to  four  diabetics 
to  reduce  the  sugar  (N.  Y.  Med.  Rec,  Jan.  3,  1914).  One 
developed  tubercle  bacilli  in  the  sputum  six  weeks  after  treat- 
ment, dying  on  the  ninth  day  after  the  last  dose. 

"Since  the  above  article  was  put  in  type,  Dr.  Ralph  Matson, 
Director  of  the  Portland  Open  Air  Sanatorium,  has  written 
that  seventeen  per  cent  of  his  cases  give  a  history  of  previous 
typhoid,  and  that  he  estimates  that  the  tuberculosis  is  a  direct 
sequence  in  ten  per  cent  of  all  his  cases.  Two  recent  cases 
attributed  their  tuberculosis  to  typhoid  vaccine  received  when 
in  apparent  perfect  health.  They  volunteered  the  information 
without  question  on  his  part." 

In  the  American  Army  during  the  recent  world  w^ar  sanita- 
tion was  the  very  best  tliat  sanitary  skill  could  make  it,  but 
where  sanitation  was  neglected  as  in  the  following  instance 
the  fact  that  the  soldiers  had  been  inoculated  against  typhoid 
and  paratyphoid  did  not  prevent  them  from  contracting  the^ 
disease. 

The  following  extracts  are  from  an  article  by  Walter  D. 
McCaw,  Colonel,  Medical  Corps,  Chief  Surgeon,  appearing  in 
"Public  Health  Reports",  the  official  weekly  bulletin  of  the 
United  States  Public  Health  Service,  for  March  3S,  IDlD: 

P.  60.5.  "In,  view  of  the  appearance  and  continued  inci- 
dence of  fevers  of  the  typhoid-paratyphoid  group  in  many 
units  of  the  American  Expeditionary  Forces  during  the  past 
five  months,  it  is  deemed  essential  to  review  this  subject  at 
the  present  time,  particularly  from  the  viewpoint  of  early 
diagnosis,  prevention,  and  control. 

"The  occurrence  and  distribution  of  typhoid-paratyphoid  in 
our  troops  has  constantly  and  continuously  been  brought  to 
the  attention  of  all  medical  officers  serving  with  the  American 
Expeditionary  Forces  through  the  medium  of  the  weekly  bul- 
letin of  diseases.     It  would  appear,  however,  that  many  offi- 


99 

cers  have  utterly  failed  to  grasp  the  significance  of  these  re- 
ports-and  warnings,  a  fact  which  may  be  due  to  a  false  sense 
of  security  under  the  popular  belief  that  vaccination  against 
typhoid  and  paratyphoid  gives  a  complete  immunity  even  in 
the  midst  of  gross  insanitary  conditions.     *     *     * 

P.  606.  "In  July,  1918,  a  replacement  unit  consisting  of  248 
men  from  Camp  Cody,  N.  Max.,  reached  England  with  ty- 
phoid prevaihng  extensively;  98  men,  or  39.5  per  cent,  had 
typhoid  and  the  case  death  rate  was  8.43  per  cent.     *     *     * 

P.  607.  "(c)  In  August,  1916,  a  small  but  severe  epi- 
demic occurred  in  a  detachment  of  Engineer  troops  stationed 
at  Bazoilles.  In  this  unit  15  cases  of  typhoid  occurred,  with 
a  death  rate  approximating  10  per  cent.     *     *     * 

"(d)  During  the  Chateau-Thierry  offensive  diarrheal  dis- 
eases were  very  prevalent  in  the  troops  engaged — approxi- 
mately 75  per  cent.  It  was  demonstrated  bacteriologically 
in  this  area  that  the  prevailing  intestinal  diseases  were  simple 
diarrhea,  bacillary  dysentery,  typhoid,  paratyphoid  A  and 
B     *     *    * 

"(f)  Following  the  offensive  in  the  Argonne  sector,  ty- 
phoid and  paratyphoid  began  to  be  reported  from  practically 
all  divisions  engaged  in  that  offensive.  *  *  *  More  than 
300  cases  of  typhoid-paratyphoid  may  be  attributed  to  the 
Argonne  offensive.  Eight  hundred  and  seventy-four  typhoids 
and  paratyphoids  have  been  reported  in  the  American  Ex- 
peditionary Forces  since  October  1,  1918.     *     *     *" 

From  a  physical  standpoint  our  soldiers  were  the  very  pick 
of  the  nation. 

.  They  were  taken  from  the  most  rugged  years  of  human 
life  and  from  these  all  who  were  in  any  way  subject  to  dis- 
ease were  eliminated.  They  were  then  put  into  active  out- 
of-door  life,  rigidly  supervised  and  in  addition  were  abso- 
lutely turned  over  to  the  allopathic  medical  profession  -who  in- 
jected into  their  blood  all  the  "preventatives"  at  present  in 
favor. 

There    was   no    restriction ;    no    choice   and   no   resistance. 


100 

Everything  the  medical  authorities  would  like  to  have  the 
opportunity  to  do  to  the  civilian  they  had  the  authority  to  do 
to  the  soldier  and  they  did  it. 

The  Reports  of  the  Surgeon  General  of  the  U.  S.  Army 
for  1918  and  1919  containing  statistics  of  the  health  condi- 
tions of  the  United  States  Army  for  the  calendar  years  1917 
and  1918  respectively  shows  very  conclusively  that  medical 
control  when  put  into  practice  means  more  cases  of  sickness 
and  death  instead  of  less. 

The  death  rate  of  American  troops  in  all  countries  was 
4.5  in  1910  and  increased  to  6.3  in  1917.  For  enUsted 
men,  American  troops  in  the  United  States  the  death  rate 
from  disease  for  1918  was  21,93.  These  men  were  stationed 
in  this  country  so  that  exposure  from  battle  was  not  a  factor. 
To  compare  favorably  with  the  death  rate  of  the  civil  popula- 
tion in  the  same  age  group  in  this  country  the  death  rate  of 
soldiers  in  the  United  States  should  have  been  many  times 
less  than  it  actually  was.  In  fact,  it  was  higher  than  the 
death  rate  of  the  population  as  a  whole  in  the  registration 
area  in  the  United  States  in  1918,  which  was  18. 

The  total  number  of  admissions  to  hospitals  for  diseases 
for  the  year  1918  for  enlisted  men  of  the  American  Army 
amounted  to  2,326,632  cases.  For  enlisted  men  the  highest 
admission  rate  was  in  'the  United  States.  It  was  1,293.62  per 
1,000  men,  the  total  number  of  cases  being  1,694,954.  In  other 
words,  as  an  average  every  enlisted  soldier  in  the  United 
States  had  to  go  to  the  hospital  once  and  some  of  them  twice 
during  the  year  1918  on  account  of  sickness. 

The  total  number  of  days  lost  from  disease  for  the  year 
1918  was  40,692,302.  This  is  equivalent  to  111,486  men  re- 
maining idle  throughout  the  year  at  the  expense  of  the  Gov- 
ernment on  account  of  illness.  The  loss  of  time  among  sol- 
diers in  the  United  States  in  1918  amounted  to  24,812,769 
days. 

Adding  the  discharge  rate  of  84.68  per  1,000  of  soldiers  in 
the  United  States  to  the  death  rate  of  21.93  it  would  mean  a 


101 

total  of  106  men  out  of  every  thousand  soldiers  in  the  United 
States  who  were  unable  to  serve  because  of  illness  or  death. 
To  this  number  also  should  be  added  a  part  or  all  of  the  51.88 
per  1,000  non-effectives. 

EXPERIENCE  IN  THE  NAVY 

The  failure  of  medical  control  during  1918  was  just  as  com- 
plete in  the  Navy  as  in  the  Army. 

According  to  the  Report  of  the  Surgeon  General  of  the 
Navy  "all  preventive  measures  which  seemed  logical,  either 
from  a  priori  reasoning  or  because  of  seemingly  good  effects 
claimed  for  them  elsewhere  during  the  year  or  in  previous 
epidemics,  were  tried  in  the  Navy." 

In  spite  of  this,  the  death  rate  in  the  naval  forces  ashore 
in  the  United  States  in  1918  for  Influenza  and  pneumonia  (all 
forms)  was  18.77  per  1,000  while  that  of  the  population  gen- 
erally in  the  United  States  in  1918  for  the  same  diseases  was 
5.83  per  1,000  and  18  per  1,000  for  all  diseases. 

Notwithstanding  compulsory  vaccination  against  smallpox, 
typhoid  and  paratyphoid  in  the  Army  there  were  768  cases  of 
typhoid  in  1918;  624  cases  of  smallpox;  73  cases  of  para- 
typhoid A.  and  34  cases  of  paratyphoid  B. 

The  number  of  admissions  in  the  army  in  1918  on  account 
of  typhoid  vaccination  was  23,191  and  the  number  on  account 
of  vaccinia  was  10,830.  In  1917  there  were  a  total  of  19,608 
admissions  on  account  of  typhoid  vaccination  -and  vaccinia. 
This  would  make  a  total  of  53,629  soldiers  who  were  made 
sick  for  the  two  years  directly  ascribed  to  typhoid  and  small 
pox  vaccination. 

The  compulsory  medical  treatment  and  supervision  to 
which  the  soldiers  and  sailors  were  subjected  was  not  only 
the  cause  of  many  of  them  being  sent  to  the  hospital  but  may 
account  for  the  low  resisting  power  of  the  soldiers  and  sailors 
whereby  so  many  of  them  became  ill  from  influenza,  tuber- 
culosis and  other  diseases. 


102 
TUBERCULOSIS  CAMPAIGN  A  FAILURE 

Campaign  Founded  on  Fear. — The  popularizing  of 
knowledge  of  the  tubercle  bacillus,  as  stated  in  an  editorial  in 
the  Journal  of  the  American  Medical  Association,  January  3, 
1914,  referring  editorially  to  an  address  by  Dr.  E.  R.  Baldwin 
of  Saranac  Lake,  has  given  rise  to  widespread  fear  among 
physicians,  nurses  and  the  laity.     It  says: 

"He  points  out  the  need  of  applying  a  check  to  phthisiopho- 
bia,  which  'has  had  no  check  from  the  time  the  knowledge  of 
the  bacillus  was  popularized.  Cornet's  dust  experiments  first 
gave  the  impulse  to  a  fear,  followed  by  Flugge's  droplet  in- 
fection, which  has  aggravated  the  solicitude  felt  by  physicians 
and  nurses,  and  which  has  been  gradually  spread  to  the  laity.' 
Not  until  the  recent  researches,  briefly  considered  in  the  fore- 
going, have  we  had  a  proper  understanding  of  the  great  power 
of  defense  of  which  the  average  adult  is  capable,  although 
not  a  few  careful  clinical  observers  have  pointed  out  evi- 
dence that  thei  constantly  exposed  husbands  and  wives  with 
consumptive  mates  show  no  such  morbidity  as  a  high  degree 
of  contagiousness  would  necessarily  produce,  and  the  inci- 
dence of  tuberculosis  in  physicians  and  nurses  in  tuberculosis 
hospitals  is  not  indicative  of  a  ready  infection  with  the  omni- 
present bacilli." 

Dr.  Thomas  J.  Mays  of  Philadelphia  has  written  a  num- 
ber of  articles  reviewing  the  failure  of  anti-tuberculosis  cam- 
paigns in  the  past  which  were  founded  on  the  basis  of  regis- 
tering consumptives  and  treating  them  as  the  subjects  of  con- 
tagious diseases.  In  an  article  in  the  New  York  Medical 
Journal  for  September  26,  1914,  he  says: 

'Tn  America  this  movement  started  in  the  early  nineties  and 
swept  over  the  country  like  a  tidal  wave.  Being  thus  fairl)/ 
launched,  and  in  order  to  make  itself  at  least  more  conven- 
tional, it  adopted  the  tactics  of  the  Grand  Duke  of  Tuscany 
when  he  consulted  the  Florence  School  of  Medicine  concern- 
ing- this  same  question  in  1754;  and  sought  ofificial  recogni- 


103 

tion  from  the  College  of  Physicians  of  Philadelphia,  the  old- 
est, most  renowned,  and  most  celebrated  medical  institution 
in  America.  The  college,  like  its  predecessor  the  Florence 
school,  rejected  the  proposal  and  instead  passed  the  follow- 
ing resolution:  'The  College  of  Physicians  of  Philadelphia 
believes  that  the  attempt  to  register  consumptives  and  to  treat 
them  as  the  subjects  of  contagious  disease  would  be  adding 
hardship  to  the  lives  of  these  unfortunates,  stamping  them  as 
outcasts  of  society.  In  view  of  the  chronic  character  of  the 
malady,  it  could  not  lead  to  any  measures  of  value  not  other- 
wise obtainable.' 

"This  resolution  was  at  that  time  regarded  by  the  friends 
of  the  crusade  as  a  marked  retrogression,  and  as  a  bar  to  the 
achievement  of  a  wonderful  boon  to  humanity,  but  when 
viewed  in  the  light  of  the  stern  and  unbending  facts  of  past 
history,  of  how  this  cold-blooded  movement  ostracises  mil- 
lions of  our  fellow  countrymen  at  the  present  day;  of  the 
millions  more  who  are  to  share  the  same  fate;  of  its  respon- 
sibility for  the  increased  death  rate  of  this  disease  during  the 
last  dozen  years ;  it  reads  like  an  inspired  prophecy." 

Value  of  Sanatoriums  Overestimated. — In  line  with  the 
anti-tuberculosis  campaign  which  was  founded  on  the  basis 
of  registering  consumptives  and  treating  them  as  the  subjects 
of  contagious  diseases  the  various  state  legislatures  have  been 
besieged  with  requests  to  authorize  the  expenditure  of  mil- 
lions upon  millions  of  dollars  for  sanatoriums.  That  sana- 
toriums have  failed  to  show  better  lasting  results  than  prop- 
erly conducted  home  treatment  is  the  opinion  of  Dr.  Maurice 
Fishberg,  Clinical  Professor  of  Tuberculosis,  New  York  Uni- 
versity and  Bellevue  Hospital  Medical  College,  in  a  recent 
book  by  him  entitled  "Pulmonary  Tuberculosis".     He  says: 

P.  507.  "In  the  available  institutions  there  is  hardly  place 
for  5  per  cent  of  the  existing  proper  cases.  To  provide  ac- 
commodations for  all  suitable  cases  in  the  United  States,  sev- 
eral billions  would  have  to  be  invested  in  buildings  and  equip- 
ment,  and  then  at  least  $100,000,000   annually   for  mainte- 


104 

nance.  Even  the  most  enthusiastic  of  those  engaged  In  the 
campaign  for  the  control  of  tuberculosis  are  not  hopeful  of 
ever  raising  such  enormous  funds.     .     . 

P.  508.  "It  can  be  stated  v/ithout  fear  of  meeting  proofs 
to  the  contrary  that,  on  the  whole,  sanatoriums  do  not  show 
better  lasting  results  than  properly  conducted  home  treatment. 
In  this  country,  hardly  any  State  or  municipal  sanatoriums 
have  published  satisfactoi-y  reports  with  comparative  statistics 
showing  the  results  attained  as  compared  with  a  similar  group 
of  patients  treated  in  their  homes.  The  most  competent  com- 
pilations of  statistics  have  been  published  by  Lawrason  Brown 
and  Pope  about  the  discharged  patients  from  Saranac  Lake, 
and  by  Herbert  Maxon  King  of  the  Loomis  Sanatorium.  To 
be  sure,  Brown  shows  that  five,  ten,  and  even  eighteen  years 
after  discharge  some  of  the  patients  were  found  alive  and 
even  efficient  at  their  occupations.  But  the  average  life  of 
the  consumptive  outside  of  the  institution,  under  any  mode 
of  treatment,  has  been  found  to  be  between  six  or  seven  years. 
Stadler  reports  that  five  years  after  the  onset  of  the  disease 
one-half  of  tuberculous  patients  are  found  who  are  able  to 
work  without  sanatorium  treatment.  There  are  similar  sta- 
tistics available  for  other  countries,  and  I  have  no  doubt  that 
in  the  United  States  we  would  find  conditions  the  same. 
King's  conclusion  as  to  the  value  of  the  sanatorium  treatment 
is  that  his  inquiry  'clearly  demonstrates  the  uncertainty  of 
apparent  immediate  results  of  treatment.' " 

Statistics  Fail  to  Show  Any  Favorable  Results  from  Anti- 
Tuberculosis  Campaign. — Notwithstanding  the  fact  that 
millions  upon  millions  of  dollars  are  annually  expended  in  the 
campaign  against  tuberculosis  for  the  medical  examination 
and  treatment  of  tuberculosis  patients  and  for  a  nation-wide 
propaganda  explaining  medical  theories  regarding  the  disease 
little  or  no  progress  can  be  shown  due  to  the  campaign.  This 
is  admitted  by  George  Thomas  Palmer  of  Springfield,  Illi- 
nois, in  an  article  entitled  "The  Need  for  a  Broader  Program 
in  the   Campaign  Against  Tuberculosis,"  published  in  "The 


105 

American  Review  of  Tuberculosis,"  a  monthly  publication 
issued  by  the  National  Tuberculosis  Association,  Baltimore, 
Md.,  for  July,  1919,  in  ^vhich  he  says : 

P.  268.  "The  optimistic  answer,  so  commonly  employed 
by  popular  health  educators  and  propagandists,  to  the  effect 
that  the  mortality  from  tuberculosis  has  been  decreased  25 
per  cent  during  the  past  fifteen  years,  during  which  the  or- 
ganized warfare  against  the  disease  has  been  in  operation,  is 
not  so  satisfying  or  convincing  as  it  appears.     .     . 

"The  first  tuberculosis  society  created  in  the  United  States 
was  that  established  in  1892  at  Philadelphia.  This  may  be 
taken  as  the  beginning  of  the  organized  campaign  in  the  na- 
tion. During  the  succeeding  twenty  years,  or  up  until  1911, 
the  death  rate  per  10,000  of  population  in  American  cities 
decreased  from  23.8  to  16.6,  or  a  decrease  of  30.25  per  cent. 

"But  unfortunately  for  the  enthusiasts  who  argue  only  from 
statistics,  during  the  preceding  twenty  years,  from  1872  to 
1891,  and  entirely  prior  to  the  first  adoption  of  an  American 
tuberculosis  program,  the  rate  per  10,000  of  population  had 
fallen  from  33.9  to  24.5,  or  a  decrease  of  27.47  per  cent.  In 
other  words,  the  rate  of  decrease  during  the  first  twenty 
years  of  anti-tuberculosis  propaganda,  over  the  preceding 
twenty  years,  was  something  less  than  3  per  cent. 

P.  269.  "In  fact,  Hoffman  pointed  out,  from  such  statis- 
tics as  vv^ere  available,  that  in  the  cities  of  New  York,  Phila- 
delphia and  Boston,  the  tuberculosis  death  rates  had  quite 
steadily  declined  for  a  period  of  one  hundred  years,  from 
something  over  450  per  100,000  of  population  in  1812  to  less 
than  200  per  100,000  in  1911,  the  more  decided  decrease  be- 
ginning about  1881,  or  eleven  years  before  the  first  organized 
tuberculosis  work  in  America;  but,  incidentally,  at  about  the 
time  of  Koch's  discovery  of  the  tubercle  bacillus. 

P.  271.  "Coincident  with  the  descending  curve  in  tubercu- 
losis mortality,  people  were  living  cleaner,  better  and  more 
wholesome  lives  and  interest  in  general  health  was  steadily  in- 
creasing.    While  we  were  passing  through  our  early  hysterical 


106 

fear  of  infection,  in  our  frenzied  battle  with  the  tubercle  bacil- 
lus, and  were  awakening  from  our  over-colored  dreams  of 
short  cuts  to  cure,  scores  of  medical  and  social  agencies  were 
coming  into  life  trying  to  solve  the  problems  of  better  living 
and  of  better  health.  What  part  these  agencies  have  had,  since 
1882,  in  shaping  the  downward  curve  of  tuberculosis  mortality, 
is  beyond  accurate  determination.  Our  thoughtful  conjecture 
is  that  it  has  been  large,  and  so  believing,  we  must  consider 
to  what  greater  extent  these  forces  and  agencies  may  be  em- 
ployed in  continuing  that  curve  which  is  still  too  far  from  the 
bottom  of  the  scale." 

Failure  of  Medical  Control  in  Influenza  Epidemic. — The 
"Illinois  Health  News,"  the  Official  Monthly  Bulletin  of  the 
State  Department  of  Public  Health  of  Illinois  for  December, 
1918,  published  a  letter  written  by  an  Illinois  health  officer 
ridiculing  the  various  proposed  measures  for  the  control  of 
influenza  offered  by  the  physicians  in  charge  of  or  employed 
by  health  departments.  The  letter,  which  is  written  as  a  joke, 
reflects  the  manner  in  which  physicians  generally  in  charge 
of  health  departments  made  the  most  drastic  regulations  that 
the  public  would  tolerate  for  the  alleged  prevention  of  in- 
fluenza, one  health  officer  claiming  that  one  thing  was  of 
value  and  the  next  ridiculing  the  method  proposed  by  the 
first  and  recommending  something  else.  The  following  is  the 
article  in  the  "Illinois  Health  News"  referred  to: 

P.  216.  "An  Illinois  health  officer,  who  attended  the  re- 
cent sessions  of  the  American  Public  Health  Association  in 
Chicago,  to  learn  better  methods  of  handling  influenza  in  his 
community,  wrote  the  following  letter  home  to  his  ever-sym- 
pathetic friend,  the  town  druggist: 

"Dear  Bill:  The  evening  'session  is  just  over.  From 
eminent  scientists  whose  names  are  known  all  over  Elk  jaw 
County  I  find  that  influenza  ain't  influenza,  but  had  better 
be  designated  as  the  X-disease.  It  is  transmitted  entirely  through 
the  mouth  by  way  of  camp  kits  and  the  reason  face  masks 
are  valuable  is  because  they  keep  your  fingers  out  of  your 


107 

mouth.  At  the  same  time,  it  ain't  what  I  jtist  said ;  but  is  due 
to  droplet  infection  from  coughing  and  sneezing  for  which 
reason  one  city  overcame  the  infection  by  everybody  wearing 
masks  while  in  another  town  where  everybody  wore  masks 
the  disease  was  worse  than  if  they  hadn't.  Face  masks  are 
a  sure  preventative  except  where  they  are  not,  in  which  case 
they  are  all  piffle  and  the  same  is  true  with  closing  up  every- 
thing some  places,  stopping  the  disease  by  general  closing  and 
others  making  things  much  better  by  keeping  everything  wide 
open.  One  guy  from  the  south  said  that  closing  churches 
didn't  prevent  crowds  in  Chicago ;  but  did  in  Alabama.  Noth- 
ing was  said  about  closing  up  crowds  of  two  after  meeting 
which  is  a  close  contact  problem  in  our  town.  Vaccination 
was  found  of  great  value  in  231  communities  and  not  worth 
a  whistle  in  232  with  one  man  not  voting.  The  meeting  is 
going  to  hold  over  and  we  are  going  to  pass  resolutions.  Just 
after  the  meeting  adjourned,  I  met  Joe  Patchen,  in  the  hard- 
ware business  in  Dallas.  He  had  been  having  a  session  a  few 
stories  below  in  the  hotel.  He  says  the  only  question  he  had 
to  solve  was  whether  ice  skating  was  chiefly  in  tights  or  for 
tights.    He  looked  the  part,  and  has  an  easy  job. 

"Sincerely  yours, 

"Abe. 
"P.  S. — Please  wire  me  fifty.     I  don't  dare  draw  on  the 
health  department  since  I  have  spilled  all  I  knew  since  com- 
ing here  and  am  now  a  sanitary  vacuum,  if  you  know  what 
I  mean. 

"Second  P.  S. — Resolutions  just  passed  by  special  commit- 
tee. I  am  back  where  I  was  before.  Never  mind  wiring. 
I  can  come  home  at  once  and  have  money  enough  for  that." 

The  various  measures  adopted  by  health  officers  for  the  al- 
leged control  of  influenza  are  not  looked  upon  by  the  public 
as  a  joke.  The  closing  of  churches,  theaters  and  schools; 
regulations  in  many  cities  requiring  everyone  to  wear  a  mask 
while  in  public  places,  and  the  segregation  of  large  numbers 
of  persons  interfered  with  business  and  with  the  normal  pur- 


108 

suits  of  the  individual  in  such  a  manner  as  to  constitute  a 
serious  charge  against  persons  responsible  for  such  measures 
unless  it  can  be  shown  that  they  were  necessary. 

The  Journal  of  the  American  Medical  Association  Novem- 
ber 2,  1918  in  referring  to  the  measures  taken  in  the  District 
of  Columbia  to  combat  the  epidemic  mentions,  "the  declara- 
tion of  the  District  of  Columbia  as  a  sanitary  zone;  making 
influenza  a  reportable  disease  and  requiring  the  segregation 
of  persons  suffering  with  it;  closing  of  schools,  churches,  the- 
aters, and  other  places  of  public  assemblage,"  etc.  and  says, 
"In  spite  of  all  this  the  impression  is  current  that  the  epi- 
demic has  simply  burnt  up  all  the  available  susceptible  fuel 
and  has  passed  on  to  new  areas." 

It  is .  worth  noting,  that  in  the  smallest  commonwealth  in 
the  United  States  where  the  citizens  cannot  protest  effectively 
against  public  control,  having  no  vote,  which  little  com- 
monwealth had  the  direct  cooperation  of  the  great  Public 
Health  Service,  no  protection  to  the  public  is  observable.  In- 
deed, it  had  one  of  the  worst  records  in  the  entire  country. 

In  New  York  City,  where  according  to  Dr.  Royal  S.  Cope- 
land,  Commissioner  of  Health  of  that  city,  he  permitted  peo- 
ple to  go  about  their  ordinary  affairs  as  usual,  the  death  rate 
from  influenza  and  pneumonia  during  the  influenza  epidemic 
of  1918  was  only  14.4  per  thousand  population  as  compared 
to  20.8  per  thousand  population  in  Washington,  D.  C.  and 
25.8  in  San  Francisco,  both  of  which  tried  a  number  of  ex- 
treme and  irrational  measures  for  the  prevention  of  influenza. 


CHAPTER  X 

THE   CONSTITUTION    A    PROTECTION    AGAINST 
STATE  MEDICINE 

"We  hold  these  truths  to  be  self  evident:  That  all  men  are  created 
equal;  that  they  are  endowed  by  their  Creator  with  certain  unalien- 
able rights;  that  among  these  are  life,  liberty  and  the  pursuit  of 
happiness." — Declaration  of  Independence. 

THE  fact  that  the  Constitution  of  the  United  States  con- 
tains a  great  many  provisions  to  protect  the  rights  of  the 
people  is  of  great  importance  as  a  protection  against  medical 
encroachments  on  the  rights  of  the  people.  The  United  States 
Constitution  is  above  Congress,  the  courts  and  the  President. 
It  is  the  fundamental  law  which  fixes  and  determines  the  form 
of  government  that  exists  under  it;  defines  and  limits  the 
powers  of  that  government  and  directs  its  executive,  legisla- 
tive, and  judicial  maintenance  and  action.  The  government 
and  all  its  branches  deriving  power  and  authority  soley  from 
the  Constitution,  can  only  do  what  that  Constitution  gives 
authority  to  do  as  provided  in  Article  IX  and  X  as  follows: 

"The  enumeration  in  the  Constitution  of  certain  rights, 
shall  not  be  construed  to  deny  or  disparage  others  retained 
by  the  people. 

"The  powers  not  delegated  to  the  United  States  by  the  Con- 
stitution, nor  prohibited  by  it  to  the  States,  are  reserved  to 
the  States  respectively,  or  to  the  people." 

One  of  the  purposes  of  the  Constitution  as  specified  in  the 
preamble  is  to  "secure  the  blessings  of  liberty  to  ourselves  and 
our  posterity."  The  first  amendment  to  the  Constitution  is 
the  culmination  of  the  struggle  for  religious  freedom  in  this 
country.    It  says: 


no 

"Congress  shall  make  no  law  respecting  an  establishment 
of  religion,  or  prohibiting  the  free  exercise  thereof,  or  abridg- 
ing the  freedom  of  speech,  or  of  the  press ;  or  the  right  of  the 
people  peaceably  to  assemble,  and  to  petition  the  government 
for  a  redress  of  grievances." 

The  fourth  amendment  is  a  protection  against  the  entrance 
of  the  home  and  unreasonable  searches  and  seizures.  It  reads: 

"The  right  of  the  people  to  be  secure  in  their  persons, 
houses,  papers  and  effects,  against  unreasonable  searches  and 
seizures,  shall  not  be  violated,  and  no  warrants  shall  issue,  but 
upon  probable  cause,  supported  by  oath  or  affirmation,  and 
particularly  describing  the  place  to  be  searched,  and  the  per- 
sons or  things  to  be  seized." 

Amendment  No.  5  specifies  that  no  person  shall  be  "de- 
prived of  life,  liberty  or  property,  without  due  process  of  law." 
Section  1,  Amendment  No.  13,  is  a  protection  against  medi- 
cal slavery  as  well  as  any  other  form  of  involuntary  servi- 
tude.   It  says: 

"Neither  slavery  nor  involuntary  servitude,  except  as  a 
punishment  for  crime,  whereof  the  party  shall  have  been  duly 
convicted,  shall  exist  within  the  United  States  or  any  place 
subject  to  their  jurisdiction." 

LIBERTY  HIGHLY  PRIZED  BY  OUR 
FOREFATHERS 

The  Declaration  of  Independence  which  was  adopted  July 
4,  1776,  declares : 

"We  hold  these  truths  to  be  self  evident:  That  all  men 
are  created  equal;  that  they  are  endowed  by  their  Creator 
with  certain  unalienable  rights;  that  among  these  are  life, 
liberty  and  the  pursuit  of  happiness.  That  to  secure  these 
rights,  Governments  are  instituted  among  men,  deriving  their 
just  powers  from  the  consent  of  the  governed,  that  when 
ever  any  form  of  government  becomes  destructive  of  these 
ends^  it  is  the  right  of  the  people  to  alter  or  to  abolish  it.'* 


Ill 

The  early  settlers  of  this  country  who  had  suffered  bitter  per- 
secution because  of  the  intolerance  shown  them,  placed  a  high 
valuation  upon  "life,  liberty  and  the  pursuit  of  happiness." 
When  the  subject  of  liberty  was  being  discussed  in  the  Vir- 
ginia convention,  Patrick  Henry  declared: 

"Is  Hfe  so  dear  or  p^ace  so  sweet  as  to  be  purchased  at 
the  price  of  chains  and  slavery?  Forbid  it.  Almighty  God! 
I  know  not  what  course  others  may  take,  but  as  for  me,  give 
me  liberty,  or  give  me  death." 

We  live  in  a  country  rich  in  experience,  reminding  us  of 
the  value  of  liberty.  Abraham  Lincoln,  whose  memory  is  so 
dear  to  all  American  citizens,  understood  the  meaning  of 
the  word  liberty.  The  Gettysburg  address  of  President  Lin- 
coln, which  has  become  a  classic  not  only  in  American  ora- 
tory, but  Tn  the  oratory  of  the  world,  refers  to  liberty  in  the 
opening  sentence.     It  says  : 

"Fourscore  and  seven  years  ago,  our  fathers  brought  forth 
on  this  continent  a  new  nation,  conceived  in  liberty  and  dedi- 
cated to  the  proposition  that  all  men  are  created  equal." 

LIBERTY  IN  JEOPARDY 

The  subject  of  medical  legislation  is  no  longer  a  subject 
of  interest  to  only  a  few  people.  Medical  inspectors  have 
invaded  the  public  schools  with  lectures  on  disease  germs, 
compulsory  vaccination  where  possible,  constant  examina- 
tions of  the  throat,  heart  and  lungs,  and  demands  for  the  re- 
moval of  the  tonsils  and  other  alleged  defects  when  in  many 
cases  at  least  there  was  no  justification  for  such  removal. 
They  are  asking  for  compulsory  medical  examinations  of 
adults  in  many  cases  and  are  making  it  difficult  to  obtain  em- 
ployment without  their  permission.  They  are  isolating  people 
under  the  theory  that  they  are  "disease  carriers,"  or  subject 
to  tuberculosis.  The  measures  which  are  being  advocated 
under  the  pretense  of  protecting  the  public  health  reach  into 
all  the  relations  of  human  life.  The  liberty  of  all  the  people 
in  this  and  future  generations  is  thereby  jeopardized. 


112 

THE  CITIZEN'S  DUTY 

The  Constitution  of  the  United  States  is  a  protection  against 
medical  slavery,  but  the  people  must  insist  upon  this  protec- 
tion if  they  are  to  maintain  it.  The  efforts  of  Assistant  Com- 
missioner of  Education  Enright  of  New  Jersey  to  interpret, 
according  to  a  Trenton  dispatch  some  years  ago,  the  clause  in 
a  statute  referring  to  the  subject  of  vaccination,  "may  exclude 
from  schools"  as  meaning  "shall  exclude  from  schools"  is  a 
good  example  of  how  a  statute  or  thel  Constitution  may  be 
misinterpreted  if  the  people  fail  to  insist  upon  their  rights. 
There  has  never  been  a  time  in  the  histor>'  of  the  United 
States  when  it  was  more  important  to  keep  in  mind  the  words 
"eternal  vigilance  is  the  price  of  liberty"  than  now  and  a 
duty  rests  upon  all  American  citizens  to  see  that  medical  free- 
dom is  established  and  maintained. 


INDEX 


Alabama  16,  17 

Allopathic  Medicine  40 

American  Association  for  La- 
bor Legislation  22 

American   Medical  Association 

16,    24,    89 

Antitoxin     (See     also     Toxin 

Antitoxin)     97 

Appendectomy     42 

Appropriations    11,  28 

Army,  U.   S 16,  35,  39,  96 

Bacteriophobia  49 

Baldwin,   Dr.   E.   R 102 

Blood-letting  40,  41 

Blue,  Dr.  Rupert : 16 

Boards  of  Health 4,  15 

Boston    49 

Brady,   Dr.   William 69 

Braisted,  William  C 16 

Brooklyn    (N.    Y.)    Citizen 5 

Burr,  Dr.  Charles  W 70 

Bushnell,  Dr.  George  E 67 

Cabot,  Dr.  Richard  C. 61,  65,  75 

California  11,  17,  22 

California    Board    of    Health 

Bulletin   68 

Card-Indexing   Everybody  23 

Carnegie,  Andrew  40 

"Carriers"    17,  32 

Children's  Bureau  72 

Chiropractic  56,  57,  60 

Christian  Science  60 

Commercialism  22,  82,  88 

Compulsory  Health  Insurance..  22 
Compulsory  Medicine  

14,  31,  49,  75,  88,  92,  96 


Connecticut    17 

Constitution,  U.  S 14,  20,  77,  109 

Copeland,  Dr.  Royal  S 108 

Davis,  Dr.  D.  J 35,  97 

Declaration  of  Independence....l09 
Department   of    Health    (See 

National    Department    of 

Health) 

Diagnosis     60,  65 

Diphtheria    ....32,    47,    50,    .76,    97 

District    of    Columbia 108 

Dixon,  Dr.  Samuel  G 14 

Draft  Figures  73 

Drake,  Dr.  C.  St.  Clair 36 

Draper,   Andrew   S 83 

Eclectic  Medicine  57,  60 

Educational   Requirements    63 

Enright,    Assistant     Commis- 
sioner of  Education 112 

Epilepsy  45 

Evans,  Dr.  W.  A 27,  38 

Examinations     (See    Medical 
Examinations) 

Face  Masks  -49,  107 

Fads  In  Medicine 42 

Family  Income  9 

Favill,  Dr.  H.  B 27 

Fear 4,  49,  70,  102 

Fishberg,  Dr.  Maurice 103 

Fisher,  Prof.  Irving 21 

Foot  and  Mouth  Disease 89 

France,  Senator  Joseph  1 23 

Furstman,  Dr.  J.  M 38 

Germ  Theory  4,  30,  49,  102 


114 


Gettysburg  Address  Ill 

Gorgas,  W.   C 11,  26,  57 

Green,  Dr.  Frederick  R 3,  17 

Harris,  Dr.  Louis  1 36 

Health  Boards    (See   Boards 

of  Health) 
Health  Insurance  (See  Com- 
pulsory  Health   Insurance) 

Heiser,  Dr.  Victor  G 8,  96 

Hektoen,  Dr.  Ludvig 62 

Hemenway,  Dr.  Henry  B 20 

Henry,    Patrick HI 

Higgins,   Chas.   M 88 

Higher  Living  Conditions....8,  106 

History  of  Medicine 40 

Hodge,  Dr.  J.  W 49,  50 

Hoffman,  Frederick  L.,  LL.  D    2 
Homeopathy  40,  58,  60 

Illinois  Health  News 106 

Illinois   Medical  Journal 28 

Indiana    - —  1'' 

Infant    Mortality     (See    also 
Maternity  and  Infancy  Care)      9 

Infantile  Paralysis  5 

Influenza  68,  101,  106 

Iowa  -  17 

James,  Prof.  William 56,  57 

Japan   • 86 

Jenner,  Edward  83 

Journal  of  the  American  Med- 
ical  Association   2,   22,   47,    52, 
60,   76,   102,   108 

Kansas  — — 17 

Kansas  State  Board  of  Health 

Bulletin   „ 9 

Kerr,  J.  W 92 

Kinsella,  Dr.  Ralph  A 33 

Knowles,  Morris 15 


Lancet-Clinic 25,  69 

Laws  17,  49,  91 

Liberty  109,  111 

Lincoln,  Abraham  „ Ill 

Locomotor  Ataxia  44 

Louisville      (Ky.)      Courier- 
Journal    6 

Massachusetts    —  12 

Maternity  and  Infancy  Care..9,  28 

Mays,  Dr.  Thomas  J „....102 

McCaw,  Walter  D 39,  98 

Mclntire,  Dr.    Charles 4 

McLaughlin,  Allan  J 21 

Mechanotherapy   57 

Medical     Certificate     Before 

Marriage  17 

Medical  Examinations  

17,  22,  36,  50,  65 

Medical   Practice   Acts 17,  56 

Medical  Teachings..4,  17,  29,  49,  71 

Meigs,  Dr.  Grace  L 72 

Michigan  17 

Millard,  Dr.  C.  Killick. 84 

"Millions  Upon  Millions" 21 

Myers,  Dr.  Park  L. 49,  53 

National   Department  of 

Health    18,  27 

National    Education    Associa- 
tion     26 

Naturopathy    57 

Navy,  U.  S 16,  101 

New   Jersey   ~ 17,  112 

New  York  - „ 17 

New  York  City. 36,  108 

New   York  City   Department 

of  Health  34 

New  York  Evening  Post 77 

New  York  Medical  Journal..71,  87 

New  York  Sun....~ .    6 

Nevada    ~ 17 

Non-Allopathic  Systems  40 


115 


North    Dakota 17,  92 

Nottingham,      M.A.      Ph.D., 
LL.D ....- 65,  79 

Opsonic  Index  63 

Oregon  ~ 17 

Osteopathy  56,  57,  60 

Palmer,  George  Thomas 104 

Pennsylvania   11 

Peterson,  Dr.  Frederick 43 

Phthisiophobia 103 

Physical  Education  28 

Pitcairn,  John  83 

Police  Power  21 

Poverty   9 

Preventive  Medicine  29 

Public  Health  Service 

....„ 10,  16,  21,  47,  108 

Ravenel  Dr.,  Mazyck  P 30 

Rest   Cure   45 

Rhea,  Lavi^rence  F.  vs.  Board 

of  Education  92 

Robinson,  Justice  93 

Rosenau,   Dr.   Milton  J 87 

Rucker,  W.  C 1 

Rural  Districts  73 

Sanitation  6,  11,  37,  81,  84,  98 

Sanatoriums    „ 49,  103 

Schick  Test  47 

Sectarianism    _ 57 

Shaw,  Dr.  Henry  L.  K 33,  37 

Showalter,  William  Joseph 7 

Simon,    Charles   E 17,  33 

Smallpox     83 

Smallpox  Inoculation  82 


Soper,  George  A. _ 6 

State  Medicine  _ 1,  14 

Sterilization  of  Criminals 17 

Stripping  School  Children 69 

Styles  in  Medical  Legislation....  17 

Tetanus   88 

Tonsils  and  Adenoids 46,  62 

Toxin    Antitoxin    —  47 

Trask,  John  W 86 

Trephining    45 

Tuberculosis  8,  49,  67,  97,  102 

Typhoid  Fever 7,  17,  39,  98 


Utah 


93 


Vaccination    Against    Small- 
pox   17,  49,  83,  101 

Vaccination  Against  Typhoid 

17,  39,  97,  101 

Vaccines  and   Serums....31,  43,  97 

Van  Derslice,  Dr.  J.  W 18 

Vaughan,  Dr.  Victor  C. 21,  39 

Wallace,     Professor     Alfred 

Russel    83 

Washington    -  17 

Washington,  George  41 

Webster,  Daniel  14 

White,  Dr.  Joseph  A. 33 

Wisconsin  _ 17 

Women's    Clubs   36 

Woodruff,  Lieut.Col.  Chas.  E.  97 

Youth's  Companion  71 

Zeisler,  Dr.   Joseph 43,  62 


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